Individual
JIMMIE STONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
851042 US HIGHWAY 17, YULEE, FL 32097-2845
(904) 633-0670
Mailing address
PO BOX 44008, UFJP - PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3199
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110000930
VA
363AM0700X
Medical Physician Assistant
Primary
PA 9104733
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004908-00
—
FL
Enumeration date
05/01/2006
Last updated
02/10/2009
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