Provider Demographics
NPI:1720859119
Name:HALTON, JACK NEELY III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:NEELY
Last Name:HALTON
Suffix:III
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4207 S DALE MABRY HWY UNIT 2302
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1431
Mailing Address - Country:US
Mailing Address - Phone:904-521-8111
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant