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Individual

JENNIE SANTANGELO JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1348 S 18TH ST STE 100, FERNANDINA BEACH, FL 32034-4785
(904) 261-0878
(904) 277-7054
Mailing address
4800 BELFORT RD, JACKSONVILLE, FL 32256-6004
(904) 389-7205
(904) 265-4807

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103620
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
292466800
FL
01
779795344A
GA MEDICAID
GA
01
U7310Y
MEDICARE
FL
Enumeration date
05/12/2006
Last updated
03/17/2018
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