Provider Demographics
NPI:1437178928
Name:RICKETTS, JONI COLLINS (PA-C)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:COLLINS
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:NICOLE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10210 SAN JOSE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6271
Mailing Address - Country:US
Mailing Address - Phone:904-990-8484
Mailing Address - Fax:904-990-8485
Practice Address - Street 1:10210 SAN JOSE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6271
Practice Address - Country:US
Practice Address - Phone:904-990-8484
Practice Address - Fax:904-990-8485
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003872-00Medicaid
FLPA9103731OtherFL PA LICENSE
FL0038372-00Medicaid
FLFH506WOtherMEDICARE - INDIVIDUAL