Ricketts, Jeffrey D

Ricketts, Jeffrey D is an individual health care provider with primary practice located at 836 Prudential Dr Ste 1804, Jacksonville FL 32207. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Ricketts, Jeffrey D can be contacted via phone (904) 398-3888.

Contact Information

Primary practice address
836 Prudential Dr Ste 1804 Jacksonville FL 32207
Phone: (904) 398-3888
Fax: (904) 400-6675
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9103298 Florida

Profile Details

NPI number 1063495281
LBN Legal business name Ricketts, Jeffrey D
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2005
Last updated May 10th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063495281 NPPES
Florida MEDICAID 292285100

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