Provider Demographics
NPI:1861530685
Name:HUNT, JAMES BERNARD (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BERNARD
Last Name:HUNT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 RIDGE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-1446
Mailing Address - Country:US
Mailing Address - Phone:407-906-2188
Mailing Address - Fax:
Practice Address - Street 1:3950 S US HIGHWAY 17/92
Practice Address - Street 2:SUITE 1040
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3295
Practice Address - Country:US
Practice Address - Phone:407-906-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1478363A00000X
FL9109535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4152998OtherBLUE CROSS
MSP00406239OtherRAILROAD MEDICARE
MS05620342Medicaid
MSP00406239OtherRAILROAD MEDICARE