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Individual
JACE DAKOTA JOHNNY
Active
Individual
JACE DAKOTA JOHNNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, APRN, AGACNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
9106759-4405
UT
363LC0200X
Critical Care Medicine Nurse Practitioner
9106759-4405
UT
Other
Enumeration date
06/10/2019
Last updated
10/21/2021
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