Provider Demographics
NPI:1023112653
Name:TOLSON, JEAN L (PA-C)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:TOLSON
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 1:6550 N FEDERAL HWY
Mailing Address - Street 2:SUITE 512
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1404
Mailing Address - Country:US
Mailing Address - Phone:954-267-8777
Mailing Address - Fax:954-772-7801
Practice Address - Street 1:6550 N FEDERAL HWY
Practice Address - Street 2:SUITE 512
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1404
Practice Address - Country:US
Practice Address - Phone:954-267-8777
Practice Address - Fax:954-772-7801
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2563363AS0400X
FLPA0002563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0983VOtherMEDICARE PTAN
FLP00450777OtherMEDICARE RAIL ROAD
FLP00450777OtherMEDICARE RAIL ROAD