Provider Demographics
NPI:1508834631
Name:MATTHEWS, JENNIFER SUE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ROCKCREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3280
Mailing Address - Country:US
Mailing Address - Phone:352-256-3071
Mailing Address - Fax:949-695-4231
Practice Address - Street 1:204 ROCKCREEK DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3280
Practice Address - Country:US
Practice Address - Phone:800-469-9031
Practice Address - Fax:949-695-4231
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2923424-00Medicaid
GA615514103AMedicaid
FLU6122YMedicare PIN
FLP00616818Medicare PIN