MEDICARE: JENNIE SANTANGELO JOHNSON 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	PA9103620	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	U7310Y	OTHER	FL	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	:	1336190792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIE SANTANGELO JOHNSON PA-C

Provider Business Mailing Address
First Line	:	4800 BELFORT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6004
Country	:	US
Telephone Number	:	904-389-7205
Fax Number	:	904-265-4807

Provider Business Practice Location Address
First Line	:	1348 S 18TH ST STE 100
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4785
Country	:	US
Telephone Number	:	904-261-0878
Fax Number	:	904-277-7054

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/17/2018

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Directions to “ JENNIE SANTANGELO JOHNSON PA-C” Practice Location

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