MEDICARE: JAY HUNTER JOHNSTON 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	363A00000X	Physician Assistant	PA9103921	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528169612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY HUNTER JOHNSTON PA-C

Provider Business Mailing Address
First Line	:	1285 36TH ST
Second Line	:	SUITE 100
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4885
Country	:	US
Telephone Number	:	772-778-2009
Fax Number	:	772-778-2910

Provider Business Practice Location Address
First Line	:	2402 FRIST BLVD STE 204
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4838
Country	:	US
Telephone Number	:	772-462-3939
Fax Number	:	772-462-3938

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/18/2022

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