Individual
MR. JODY VICENCIO CRISOSTOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
4243 SUNBEAM RD STE 6, JACKSONVILLE, FL 32257-8975
(904) 737-1838
(904) 737-1206
Mailing address
PO BOX 57970, JACKSONVILLE, FL 32241-7970
(904) 737-1838
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1911
FL
Other
Enumeration date
06/14/2006
Last updated
04/11/2008
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