Individual
JOELLEN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
6821 W HILLSBOROUGH AVE, STE #19, TAMPA, FL 33634-5003
(813) 890-0705
(813) 890-0710
Mailing address
2810 W DR MLK BLVD, TAMPA, FL 33607-6306
(813) 877-8450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 2812
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA 2812
PHYSICIAN ASSISTANT
FL
Enumeration date
03/21/2007
Last updated
04/06/2016
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