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General NPI Number Information
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NPI Number | 1598060550
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Entity Type | Individual
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Provider Name | JEAN TAYLOR FERGUSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 8075 GATE PARKWAY W #305
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-296-2992
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Fax | 904-296-2993
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Provider Business Mailing Address
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Address Line | 8075 GATE PARKWAY W #305
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-296-2992
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Fax | 904-296-2993
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9106099
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License Number State | FL
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