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General NPI Number Information
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NPI Number | 1528169612
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Entity Type | Individual
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Provider Name | JAY HUNTER JOHNSTON PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 2402 FRIST BLVD STE 204
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City | FORT PIERCE
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State | FL
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Zip | 34950-4838
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Country | US
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Telephone | 772-462-3939
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Fax | 772-462-3938
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Provider Business Mailing Address
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Address Line | 1285 36TH ST SUITE 100
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City | VERO BEACH
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State | FL
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Zip | 32960-4885
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Country | US
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Telephone | 772-778-2009
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Fax | 772-778-2910
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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 | PA9103921
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License Number State | FL
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