Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN9351773 | FL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | APRN9351773 | FL |
NPI | 1023557386 |
---|---|
Provider Name | Jason Allen |
First Address | Jacksonville, FL 32216-6286 |
Second Address | Jacksonville, FL 32216-6286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2017 |
Last Update Date | 13/02/2019 |