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General NPI Number Information
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NPI Number | 1124540588
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Entity Type | Individual
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Provider Name | JESSICA MARIE JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 5927 OLD TIMUQUANA RD
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City | JACKSONVILLE
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State | FL
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Zip | 32210-7889
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Country | US
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Telephone | 844-937-4731
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Fax |
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Provider Business Mailing Address
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Address Line | 1244 S OCEAN SHORE BLVD
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3703
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Country | US
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Telephone | 904-556-6152
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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