Basic Information
| Provider Information | |||||||||
| NPI: | 1700236833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHONK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2627 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043087374 | ||||||||
| FaxNumber: | 9043082998 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 SPRUCE ST. | ||||||||
| Address2: | 2ND FL AREA 2 | ||||||||
| City: | ESPANOLA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875322724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053670340 | ||||||||
| FaxNumber: | 5053670263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2016 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | UO 5227 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.