Provider Demographics
NPI:1720407315
Name:WEBER, JOHNATHAN NOEL
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:NOEL
Last Name:WEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18850 B F FINLEY CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ST MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-5674
Mailing Address - Country:US
Mailing Address - Phone:904-755-2740
Mailing Address - Fax:
Practice Address - Street 1:439 SW MICHIGAN ST.
Practice Address - Street 2:MERIDIAN HEALTH
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-487-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 296175376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide