Healthcare Provider Details

I. General information

NPI: 1306740329
Provider Name (Legal Business Name): JENNA N FERGUSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 CORPORATE CENTER PKWY
JACKSONVILLE FL
32216-8079
US

IV. Provider business mailing address

6675 CORPORATE CENTER PKWY
JACKSONVILLE FL
32216-8079
US

V. Phone/Fax

Practice location:
  • Phone: 904-245-8910
  • Fax:
Mailing address:
  • Phone: 904-245-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: