Individual
MR. JARED RYAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3334 CAPITAL MEDICAL BLVD, SUITE 400, TALLAHASSEE, FL 32308-8405
(850) 877-8174
(850) 877-5636
Mailing address
3334 CAPITAL MEDICAL BLVD, SUITE 400, TALLAHASSEE, FL 32308-8405
(850) 877-8174
(850) 877-5636
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106174
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004163400
—
FL
Enumeration date
09/30/2011
Last updated
02/24/2012
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