Individual
ANDREW LYN OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
550 GEORGIA ST, STARKE, FL 32091
(904) 364-2900
(904) 364-2901
Mailing address
550 GEORGIA ST, STARKE, FL 32091-1816
(386) 336-3633
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021850300
—
FL
01
—
MEDICARE
JB638Y
FL
Enumeration date
06/08/2017
Last updated
11/21/2018
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