Provider Demographics
NPI:1770699324
Name:RAY, JANA KATHLEEN (BS,MPH,MPAS,DMSCPA-C)
Entity type:Individual
Prefix:MS
First Name:JANA
Middle Name:KATHLEEN
Last Name:RAY
Suffix:
Gender:F
Credentials:BS,MPH,MPAS,DMSCPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 TAMPA ROAD PMB213
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683
Mailing Address - Country:US
Mailing Address - Phone:850-322-6945
Mailing Address - Fax:
Practice Address - Street 1:CAMP AS SALIYAH
Practice Address - Street 2:INTERNATIONAL SOS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:00000
Practice Address - Country:US
Practice Address - Phone:850-322-6945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9102896363AM0700X
CAPA56715363AM0700X
GA006718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085.002169OtherDEPT OF FINANCIAL AND PROFESSIONAL REGULATION
IL385.005610OtherILLINOIS CONTROLLED SUBSTANCE LICENSE
IA002087OtherIOWA DEPT OF PUBLIC HEALTH MEDICAL LICENSE
FL292421800Medicaid
MN9874OtherMINNESOTA BOARD OF MEDICAL PRACTICE PHYSICIAN ASST LICENSURE (EXP 06-30-2005)
FL00005751OtherFLORIDA PRESCRIBING QUALIFICATION
HIAMD-919OtherDEPT OF COMMERCE AND CONSUMER AFFAIRS
IAUNKNOWNOtherMAGELLAN OF IOWA - BROADLAWNS MEDICAL CENTER
NY023740-01OtherDIVISION OF PROFESSIONAL LICENSING SERVICES
CAPA56715OtherDEPT OF CONSUMER AFFAIRS - PHY ASST LICENSE
1060096OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
WI1721-023OtherWISCONSIN DEPT OF REGULATION AND LICENSING
GA6718OtherPHYSICIAN ASSISTANT
FLU8969ZOtherMEDICARE
IA5101395OtherIOWA CONTROLLED SUBSTANCE ACT LICENSE (EXPIRED)
FL9102896OtherFLORIDA DEPT OF HEALTH PHYSICIAN ASST LICENSURE