Provider Demographics
NPI:1912407628
Name:POPE, JONATHAN D (AGPCNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:D
Last Name:POPE
Suffix:
Gender:M
Credentials:AGPCNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-2760
Mailing Address - Country:US
Mailing Address - Phone:352-541-0485
Mailing Address - Fax:813-566-0881
Practice Address - Street 1:2708 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-2760
Practice Address - Country:US
Practice Address - Phone:352-541-0485
Practice Address - Fax:813-566-0881
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9349601363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024125000Medicaid