Provider Demographics
NPI:1396794137
Name:HINTON, JENNIFER M (P A)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HINTON
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:998 BROWNS RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3306
Mailing Address - Country:US
Mailing Address - Phone:904-555-1212
Mailing Address - Fax:
Practice Address - Street 1:1555 KINGSLEY AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-9207
Practice Address - Country:US
Practice Address - Phone:904-278-5088
Practice Address - Fax:904-264-4910
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103166207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00239935OtherRAILROAD MEDICARE
FL296833OtherAVMED
FLY05AGOtherBCBS
FLP00239935OtherRAILROAD MEDICARE
FLU4730ZMedicare PIN