Provider Demographics
NPI:1912155490
Name:NEEDLER, JONATHAN DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:NEEDLER
Suffix:
Gender:M
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 1:155 CRYSTAL BEACH DR
Mailing Address - Street 2:STE 200
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3588
Mailing Address - Country:US
Mailing Address - Phone:850-460-2350
Mailing Address - Fax:
Practice Address - Street 1:155 CRYSTAL BEACH DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3527
Practice Address - Country:US
Practice Address - Phone:850-460-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1912155490363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant