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Contact Information

NICOLE GANNON, PA-C
4500 SAN PABLO RD S
JACKSONVILLE, FL32224-1865
 Phone: 904-953-2000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Independent Medical Examiner

202C00000X
Indicates primary specialty

NPI Profile & details for NICOLE GANNON · (Female)

NPI Number 1467881615
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 11/08/2013
Last updated 01/22/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • FL License # PA9107493
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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