Provider Demographics
NPI:1437932985
Name:MJ THE NP
Entity Type:Organization
Organization Name:MJ THE NP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MASIAI
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-278-1031
Mailing Address - Street 1:401 SW PRATER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LUCIE WEST
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:789 SW FEDERAL HWY STE 201
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2962
Practice Address - Country:US
Practice Address - Phone:561-233-1861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty