Healthcare Provider Details

I. General information

NPI: 1396855813
Provider Name (Legal Business Name): JUANITA DENAE BRACY PA-C, MPA, ATC, MED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUANITA DENAE HOLLEY ATC

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 COUNTY ROAD 210 W STE 110
ST JOHNS FL
32259-7001
US

IV. Provider business mailing address

6800 SOUTHPOINT PKWY STE 300
JACKSONVILLE FL
32216-8203
US

V. Phone/Fax

Practice location:
  • Phone: 214-580-7277
  • Fax:
Mailing address:
  • Phone: 904-634-0640
  • Fax: 904-634-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number012000864
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number306479
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60497
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15256
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: