Healthcare Provider Details

I. General information

NPI: 1427848688
Provider Name (Legal Business Name): JENNA JOSLYN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CYPRESS EDGE DR STE 202
PALM COAST FL
32164-8454
US

IV. Provider business mailing address

120 CYPRESS EDGE DR STE 202
PALM COAST FL
32164-8454
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-4280
  • Fax: 386-586-4286
Mailing address:
  • Phone: 386-586-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: