Provider Demographics
NPI:1649721085
Name:ANTHONY, DEVON M (PA-C)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:M
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-720-0599
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:1361 13TH AVE S STE 270
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3258
Practice Address - Country:US
Practice Address - Phone:904-241-7147
Practice Address - Fax:904-241-5492
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1160363A00000X
FLPA9112372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1160OtherALABAMA BOARD OF MEDICAL EXAMINERS