Basic Information
| Provider Information | |||||||||
| NPI: | 1821640624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATWELL | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3627 UNIVERSITY BLVD S STE 500 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322167405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043995678 | ||||||||
| FaxNumber: | 9043998488 | ||||||||
| Practice Location | |||||||||
| Address1: | 3627 UNIVERSITY BLVD S STE 500 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322167405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043995678 | ||||||||
| FaxNumber: | 9043998488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2019 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9112134 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.