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Individual

JENNIFER ELIZABETH FAISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C

Contact information

Practice address
1690 DUNLAWTON AVENUE, SUITE 210, PORT ORANGE, FL 32127-8980
(386) 763-4920
(386) 763-4939
Mailing address
1690 DUNLAWTON AVENUE, SUITE 210, PORT ORANGE, FL 32127-8980
(386) 763-4920
(386) 763-4939

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9104338
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA9104338
MEDICAL LICENSE
FL
Enumeration date
12/05/2007
Last updated
07/26/2011
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