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General NPI Number Information
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NPI Number | 1396855813
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Entity Type | Individual
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Provider Name | JUANITA DENAE BRACY PA-C, MPA, ATC, MED.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 3055 COUNTY ROAD 210 W STE 110
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City | ST JOHNS
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State | FL
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Zip | 32259-7001
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Country | US
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Telephone | 214-580-7277
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 SOUTHPOINT PKWY STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8203
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Country | US
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Telephone | 904-634-0640
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Fax | 904-634-0203
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 012000864
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 306479
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA60497
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA15256
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9118228
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License Number State | FL
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