Individual
INA MICHELLE SANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1551 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4124
(904) 354-4488
Mailing address
3080 COUNTRY CLUB BLVD, ORANGE PARK, FL 32073-5730
(904) 213-4298
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9101335
FL
Other
Enumeration date
01/17/2006
Last updated
03/19/2009
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