Provider Demographics
NPI:1518679745
Name:MUCHA, JENNIFER SHAY (AGAC-NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SHAY
Last Name:MUCHA
Suffix:
Gender:F
Credentials:AGAC-NP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 117345
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7345
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-858-6489
Practice Address - Street 1:14534 OLD SAINT AUGUSTINE RD STE 3210
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2645
Practice Address - Country:US
Practice Address - Phone:904-880-1260
Practice Address - Fax:904-880-1210
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2024-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021560363LA2200X, 363L00000X
FL11021560363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care