Provider Demographics
NPI:1750545638
Name:JERNIGAN, JASON PAUL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:PAUL
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 29TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2532
Mailing Address - Country:US
Mailing Address - Phone:863-781-1079
Mailing Address - Fax:
Practice Address - Street 1:1435 29TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2532
Practice Address - Country:US
Practice Address - Phone:863-781-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist