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General NPI Number Information
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NPI Number | 1003286824
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Entity Type | Individual
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Provider Name | JEFFREY LUDAN VONGJESDA M.S., APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 3728 PHILIPS HWY STE 34
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City | JACKSONVILLE
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State | FL
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Zip | 32207-6840
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Country | US
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Telephone | 904-399-2766
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Fax | 904-549-8300
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Provider Business Mailing Address
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Address Line | 3728 PHILIPS HWY STE 34
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City | JACKSONVILLE
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State | FL
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Zip | 32207-6840
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Country | US
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Telephone | 904-399-2766
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Fax | 904-549-8300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9278630
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 60962308
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95007934
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 817161
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9278630
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN9278630
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License Number State | FL
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