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General NPI Number Information
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NPI Number | 1902088586
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Entity Type | Individual
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Provider Name | JENNIFER ELIZABETH FAISON P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 1690 DUNLAWTON AVENUE SUITE 210
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City | PORT ORANGE
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State | FL
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Zip | 32127-8980
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Country | US
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Telephone | 386-763-4920
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Fax | 386-763-4939
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Provider Business Mailing Address
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Address Line | 1690 DUNLAWTON AVENUE SUITE 210
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City | PORT ORANGE
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State | FL
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Zip | 32127-8980
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Country | US
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Telephone | 386-763-4920
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Fax | 386-763-4939
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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 | PA9104338
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License Number State | FL
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