Provider Demographics
NPI:1003286824
Name:VONGJESDA, JEFFREY LUDAN (MS, APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LUDAN
Last Name:VONGJESDA
Suffix:
Gender:M
Credentials:MS, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 PHILIPS HWY STE 34
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-6840
Mailing Address - Country:US
Mailing Address - Phone:904-399-2766
Mailing Address - Fax:904-549-8300
Practice Address - Street 1:3728 PHILIPS HWY STE 34
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6840
Practice Address - Country:US
Practice Address - Phone:904-399-2766
Practice Address - Fax:904-549-8300
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9278630363LF0000X
WA60962308363LF0000X
CA95007934363LF0000X
NV817161363LF0000X
FL9278630363LF0000X
FLAPRN9278630363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care