Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tara Shannon Condrey, PA

Individual provider Physician Assistant · NPI 1083871693

Tara Shannon Condrey, PA is a Physician Assistant in Jacksonville, Florida. Qualified in 2008, 18 years ago. Practices with Florida ENT Associates Inc, a 159-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
18
Licensed in
FL
In the registry since
2008
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

11512 Lake Mead Ave Ste 531
Jacksonville, FL 32256-9680
Phone: (904) 419-2054
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9104580 (FL)

Record details

NPI number1083871693
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 21, 2008
Last updated in NPPESJanuary 6, 2025
Certification dateJanuary 6, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Florida Ent Associates Inc — 159 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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