Healthcare Provider Details

I. General information

NPI: 1164844247
Provider Name (Legal Business Name): JASON LEE JAUDON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

120 10TH AVE S APT. 8
JACKSONVILLE BEACH FL
32250-6545
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-0411
  • Fax:
Mailing address:
  • Phone: 904-304-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9250872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: