Individual
JONI COLLINS RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10210 SAN JOSE BLVD STE 4, JACKSONVILLE, FL 32257-6271
(904) 990-8484
(904) 990-8485
Mailing address
10210 SAN JOSE BLVD STE 4, JACKSONVILLE, FL 32257-6271
(904) 990-8484
(904) 990-8485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9103731
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0038372-00
—
FL
05
—
003872-00
—
FL
01
—
FH506W
MEDICARE - INDIVIDUAL
FL
01
—
PA9103731
FL PA LICENSE
FL
Enumeration date
07/18/2006
Last updated
11/27/2019
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