Provider Demographics
NPI:1942332200
Name:ERNST, JOSEPH LAURENCE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LAURENCE
Last Name:ERNST
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 1:2 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 700 DEPAUL BLDG.
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4763
Mailing Address - Country:US
Mailing Address - Phone:904-389-5333
Mailing Address - Fax:904-389-5332
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 700 DEPAUL BLDG.
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4763
Practice Address - Country:US
Practice Address - Phone:904-389-5333
Practice Address - Fax:904-389-5332
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3207363A00000X
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE PTAN
FL292776400Medicaid
FLAF662XMedicare PIN