Provider Demographics
NPI:1821640624
Name:ATWELL, EMMA E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:E
Last Name:ATWELL
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3627 UNIVERSITY BLVD S STE 500
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-7405
Mailing Address - Country:US
Mailing Address - Phone:904-399-5678
Mailing Address - Fax:904-399-8488
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-7405
Practice Address - Country:US
Practice Address - Phone:904-399-5678
Practice Address - Fax:904-399-8488
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9112134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant