Provider Demographics
NPI:1245830314
Name:KORAH, JONATHAN V (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:V
Last Name:KORAH
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 SHIRCLIFF WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4765
Mailing Address - Country:US
Mailing Address - Phone:904-308-7959
Mailing Address - Fax:904-308-7938
Practice Address - Street 1:4205 BELFORT RD STE 1100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5876
Practice Address - Country:US
Practice Address - Phone:904-296-3103
Practice Address - Fax:904-296-3106
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
FLPA9113815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant