=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366150542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IESHIA L JONES SURGICAL ASSISTANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2022
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10175 COUNTY ROAD 229
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34484-3955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-346-4945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10175 COUNTY ROAD 229
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34484-3955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-346-4945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 213502
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number | 213502
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------