Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2007-00575 | NC |
N | 207Q00000X | Family Doctor | ME111724 | FL |
NPI | 1003010307 |
---|---|
Provider Name | Jennifer Lynn Stone |
First Address | Jacksonville, FL 32205-8019 |
Second Address | Roanoke Rapids, NC 27870-5130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 11/02/2021 |