Provider Demographics
NPI:1942332135
Name:MINER, KAREN L (PA-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:MINER
Suffix:
Gender:F
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 1:550 WELLS ROAD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2951
Mailing Address - Country:US
Mailing Address - Phone:904-269-2900
Mailing Address - Fax:904-269-1140
Practice Address - Street 1:550 WELLS ROAD
Practice Address - Street 2:SUITE 17
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2951
Practice Address - Country:US
Practice Address - Phone:904-269-2900
Practice Address - Fax:904-269-1140
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
599216Medicare UPIN
FLE3616YMedicare PIN