Provider Demographics
NPI:1710388244
Name:PARKS, MORGAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 BARTRAM OAKS WALK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3243
Mailing Address - Country:US
Mailing Address - Phone:904-240-0442
Mailing Address - Fax:904-240-0471
Practice Address - Street 1:115 BARTRAM OAKS WALK
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3243
Practice Address - Country:US
Practice Address - Phone:904-240-0442
Practice Address - Fax:904-240-0471
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9108138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant