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General NPI Number Information
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NPI Number | 1629832357
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Entity Type | Organization
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Legal Business Name | PRIMARYWERX LLC
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 204 ROCKCREEK DR
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City | ST JOHNS
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State | FL
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Zip | 32259-3280
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Country | US
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Telephone | 800-469-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 204 ROCKCREEK DR
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City | ST JOHNS
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State | FL
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Zip | 32259-3280
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Country | US
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Telephone | 904-352-9957
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Fax | 352-204-1470
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER S MATTHEWS
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Credential | PA
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Telephone | 904-352-9957
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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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