Basic Information
| Provider Information | |||||||||
| NPI: | 1730458324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 E 6TH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324013661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502152337 | ||||||||
| FaxNumber: | 8508554045 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 E 6TH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324013661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502152337 | ||||||||
| FaxNumber: | 8508554045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2011 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP9258454 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | RN9258454 | FL | N | Nursing Service Providers | Registered Nurse |
No ID Information.