Provider Demographics
NPI:1902027717
Name:BADGER, JESSE QUINN OWENS (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:QUINN OWENS
Last Name:BADGER
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 1:8823 SAN JOSE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4288
Mailing Address - Country:US
Mailing Address - Phone:904-404-7044
Mailing Address - Fax:904-329-2303
Practice Address - Street 1:8823 SAN JOSE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4288
Practice Address - Country:US
Practice Address - Phone:904-404-7044
Practice Address - Fax:904-329-2303
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102404OtherPHYSICIAN ASSISTANT LIC.