Provider Demographics
NPI:1871165506
Name:ADE, CEDRICK DUCARMEL
Entity type:Individual
Prefix:
First Name:CEDRICK
Middle Name:DUCARMEL
Last Name:ADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CEDRICK
Other - Middle Name:
Other - Last Name:ADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 LINDENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7097
Mailing Address - Country:US
Mailing Address - Phone:954-383-3702
Mailing Address - Fax:
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:904-202-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA674367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant