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General NPI Number Information
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NPI Number | 1780839449
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Entity Type | Individual
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Provider Name | KRISTINA MARSH JADLOCKI PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2008
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 915 W MONROE ST STE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1177
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Country | US
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Telephone | 904-384-2240
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Fax | 904-486-2314
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Provider Business Mailing Address
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Address Line | 915 W MONROE ST STE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1177
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Country | US
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Telephone | 904-384-2240
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Fax | 904-486-2314
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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 | PA9105227
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA060056738
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9105227
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License Number State | FL
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