Healthcare Provider Details

I. General information

NPI: 1518880202
Provider Name (Legal Business Name): PERIZHANA BRONSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W MONROE ST STE 200
JACKSONVILLE FL
32204-1177
US

IV. Provider business mailing address

915 W MONROE ST STE 200
JACKSONVILLE FL
32204-1177
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-2240
  • Fax: 904-486-2314
Mailing address:
  • Phone: 904-384-2240
  • Fax: 904-486-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: