Provider Demographics
NPI:1972804557
Name:GILDIN, JONATHAN DAVID (PA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:GILDIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH STREET
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3763
Mailing Address - Country:US
Mailing Address - Phone:954-355-4665
Mailing Address - Fax:954-355-4881
Practice Address - Street 1:1625 SE 3RD AVE STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-355-4665
Practice Address - Fax:954-355-4881
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105788363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9105788OtherDOH
FL008462700Medicaid