Provider Demographics
NPI:1558483495
Name:KRISHNA, JAYA LAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:LAKSHMI
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8837 GOODBYS EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4605
Mailing Address - Country:US
Mailing Address - Phone:904-731-7650
Mailing Address - Fax:904-448-0370
Practice Address - Street 1:8837 GOODBYS EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4605
Practice Address - Country:US
Practice Address - Phone:904-731-7650
Practice Address - Fax:904-448-0370
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 105076207Q00000X
FLME113201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007624500Medicaid
FL007624500Medicaid