Healthcare Provider Details

I. General information

NPI: 1730643701
Provider Name (Legal Business Name): CHRISTINA JONES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 BLACKFOOT ST NW STE 270
COON RAPIDS MN
55433-2593
US

IV. Provider business mailing address

3433 BROADWAY ST NE STE 115
MINNEAPOLIS MN
55413-1759
US

V. Phone/Fax

Practice location:
  • Phone: 651-312-1717
  • Fax: 651-312-1570
Mailing address:
  • Phone: 651-312-1505
  • Fax: 651-312-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number12789
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: