Individual
JONATHAN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1600 SW ARCHER RD, DIVISION OF VASCULAR SURGERY - BOX 100128, GAINESVILLE, FL 32610-0128
(352) 273-5484
Mailing address
1600 SW ARCHER RD, DIVISION OF VASCULAR SURGERY - BOX 100128, GAINESVILLE, FL 32610-0128
(352) 273-5484
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9108305
FL
363AM0700X
Medical Physician Assistant
PA9108305
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014722600
—
FL
Enumeration date
08/28/2014
Last updated
05/09/2017
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