MR. JEFFREY LUDAN VONGJESDA MS ARNP NP-C NPI 1003286824

NPI Information

NPI: 1003286824
Provider Name: MR. JEFFREY LUDAN VONGJESDA, MS, ARNP, NP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
4565 US HIGHWAY 17 STE 106
FLEMING ISLAND, FL
ZIP 32003
Phone: (904) 269-4559
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MR. Jeffrey Ludan Vongjesda, MS, ARNP, NP-C is a family nurse practitioner in Fleming Island, FL with 9 years of experience. MR. Jeffrey Ludan Vongjesda, MS, ARNP, NP-C NPI is 1003286824. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4565 US HIGHWAY 17 STE 106
FLEMING ISLAND, FL
ZIP 32003-822
Phone: (904) 269-4559
Fax: (904) 269-4597

The NPI 1003286824 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/6/2015 and was last updated on 12/28/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	363LF0000X	Nurse Practitioner	Family	95007934	CALIFORNIA	No
2	363LF0000X	Nurse Practitioner	Family	817161	NEVADA	No
3	363LF0000X	Nurse Practitioner	Family	60962308	WASHINGTON	No
4	363LP2300X	Nurse Practitioner	Primary Care	APRN9278630	FLORIDA	No
5	363LF0000X	Nurse Practitioner	Family	ARNP9278630	FLORIDA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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