Provider Demographics
NPI:1760517353
Name:NADEAU, ALLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:NADEAU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 PRUDENTIAL DRIVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:904-278-2608
Mailing Address - Fax:
Practice Address - Street 1:2021 KINGSLEY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5174
Practice Address - Country:US
Practice Address - Phone:904-276-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP33557Medicare UPIN