Provider Demographics
NPI:1851399380
Name:FERRELL, JAMES E (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:FERRELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1211
Mailing Address - Country:US
Mailing Address - Phone:407-425-1566
Mailing Address - Fax:407-422-0166
Practice Address - Street 1:217 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1211
Practice Address - Country:US
Practice Address - Phone:407-425-1566
Practice Address - Fax:407-422-0166
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2972363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290395400Medicaid
FLE0521Medicare ID - Type UnspecifiedINDIV MEDICARE NUMBER
FL290395400Medicaid
FL00364Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER