Healthcare Provider Details

I. General information

NPI: 1629832357
Provider Name (Legal Business Name): PRIMARYWERX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ROCKCREEK DR
ST JOHNS FL
32259-3280
US

IV. Provider business mailing address

204 ROCKCREEK DR
ST JOHNS FL
32259-3280
US

V. Phone/Fax

Practice location:
  • Phone: 800-469-9031
  • Fax:
Mailing address:
  • Phone: 904-352-9957
  • Fax: 352-204-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER S MATTHEWS
Title or Position: OWNER
Credential: PA
Phone: 904-352-9957