MEDICARE: MS. DONNA JO SMITH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA3168	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	970010579	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306827225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA JO SMITH PA-C

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-399-1717

Provider Business Practice Location Address
First Line	:	10475 CENTURION PKWY N
Second Line	:	SUITE 303
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-5003
Country	:	US
Telephone Number	:	904-399-0350
Fax Number	:	904-399-5914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	11/18/2015

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Directions to “ MS. DONNA JO SMITH PA-C” Practice Location

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