Provider Demographics
NPI:1710654348
Name:CLEMONS, CARSON MITCHELL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CARSON
Middle Name:MITCHELL
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:EMMA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4268 OLDFIELD CROSSING DR STE 303
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7899
Mailing Address - Country:US
Mailing Address - Phone:904-325-9386
Mailing Address - Fax:904-650-2911
Practice Address - Street 1:4268 OLDFIELD CROSSING DR STE 303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7899
Practice Address - Country:US
Practice Address - Phone:904-325-9386
Practice Address - Fax:904-650-2911
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63282363A00000X
GA11875363A00000X
FL9114474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant