Provider Demographics
NPI:1700236833
Name:SHONK, JENNIFER L (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:SHONK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2627 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4712
Mailing Address - Country:US
Mailing Address - Phone:904-308-7374
Mailing Address - Fax:904-308-2998
Practice Address - Street 1:1010 SPRUCE ST.
Practice Address - Street 2:2ND FL AREA 2
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2724
Practice Address - Country:US
Practice Address - Phone:505-367-0340
Practice Address - Fax:505-367-0263
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 5227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine