MRS. JENNIFER PATRICIA JOHNSON, PA-C - NPI NUMBER 1740478981

Summary

Provider Name: MRS. JENNIFER PATRICIA JOHNSON, PA-C

NPI Number: 1740478981

Clasification: Physician Assistant (363A00000X)

Address:
550 WELLS RD
SUITE 17
ORANGE PARK, FL
ZIP 32073

Phone Number: (904) 269-2900



Detailed Information

MRS. Jennifer Patricia Johnson, PA-C is a physician assistant in Orange Park, FL. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. The assigned NPI number for this provider is 1740478981 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

550 WELLS RD
SUITE 17
ORANGE PARK, FL
ZIP 32073-969
Phone: (904) 269-2900
Fax: (904) 269-1140

The enumeration date for this NPI number is 10/12/2007 and was last updated on 7/9/2014.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363A00000X Physician Assistant PAT9104376 FL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 P01207952 OTHER FL RAILROAD MEDICARE
2 AF880X MEDICARE PIN FL
3 292932500 MEDICAID FL

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1740478981 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name JOHNSON The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name JENNIFER The first name of the provider, if the provider is an individual.
5 Provider Middle Name PATRICIA The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text MRS. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text PA-C The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider Other Last Name TOZZI Other last name by which the provider being identified is or has been known.
9 Provider Other First Name JENNIFER Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
10 Provider Other Middle Name PATRICIA Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider is or has been known by a different last name only.
11 Provider Other Name Prefix Text MS. The other name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
12 Provider Other Credential Text PA-C The other abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
13 Provider Other Last Name Type Code 1 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
14 Provider First Line Business Practice Location Address 550 WELLS RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
15 Provider Second Line Business Practice Location Address SUITE 17 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
16 Provider Business Practice Location Address City Name ORANGE PARK The city name in the location address of the provider being identified.
17 Provider Business Practice Location Address State Name FL The State code in the location of the provider being identified.
18 Provider Business Practice Location Address Postal Code 320732969 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
19 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
20 Provider Business Practice Location Address Telephone Number 9042692900 The telephone number associated with the location address of the provider being identified.
21 Provider Business Practice Location Address Fax Number 9042691140 The fax number associated with the location address of the provider being identified.
22 Provider Enumeration Date 10/12/2007 The date the provider was assigned a unique identifier (assigned an NPI).
23 Last Update Date 7/9/2014 The date that a record was last updated or changed.
24 Provider Gender Code F The code designating the provider’s gender if the provider is a person.
25 Healthcare Provider Taxonomy Code 1 363A00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
26 Provider License Number 1 PAT9104376 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
27 Provider License Number State Code 1 FL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
28 Healthcare Provider Primary Taxonomy Switch 1 Y
29 Other Provider Identifier 1 P01207952 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 1 FL
32 Other Provider Identifier Issuer 1 RAILROAD MEDICARE
33 Other Provider Identifier 2 AF880X Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
35 Other Provider Identifier State 2 FL
36 Other Provider Identifier 3 292932500 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
38 Other Provider Identifier State 3 FL
39 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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