Individual
JOHN MICHAEL TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
14540 OLD SAINT AUGUSTINE RD, SUITE 2201, JACKSONVILLE, FL 32258-7418
(904) 880-1260
(904) 880-1210
Mailing address
1325 SAN MARCO BLVD STE 200, JACKSONVILLE, FL 32207-8566
(904) 346-3465
(904) 880-1210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9102882
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292014000
—
FL
Enumeration date
06/14/2005
Last updated
11/19/2015
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