Provider Demographics
NPI:1760427355
Name:CUPP, JOSEPH F (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:F
Last Name:CUPP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:FORT
Other - Last Name:CUPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4592
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:325-373-6144
Practice Address - Street 1:4343 W NEWBERRY RD
Practice Address - Street 2:SUITE 14
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2826
Practice Address - Country:US
Practice Address - Phone:352-373-4321
Practice Address - Fax:352-373-0613
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122020700Medicaid
Q49859Medicare UPIN
FLU5425YMedicare PIN
FL291975300Medicaid