MEDICARE: JAYA LAKSHMI KRISHNA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME 105076	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558483495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYA LAKSHMI KRISHNA MD

Provider Business Mailing Address
First Line	:	8837 GOODBYS EXECUTIVE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4605
Country	:	US
Telephone Number	:	904-731-7650
Fax Number	:	904-448-0370

Provider Business Practice Location Address
First Line	:	8837 GOODBYS EXECUTIVE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4605
Country	:	US
Telephone Number	:	904-731-7650
Fax Number	:	904-448-0370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	02/10/2022

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