Provider Demographics
NPI:1811492747
Name:TRIAS, JESU MISAJON (ARNP)
Entity type:Individual
Prefix:
First Name:JESU
Middle Name:MISAJON
Last Name:TRIAS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 BROXTON BAY DR APT 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8393
Mailing Address - Country:US
Mailing Address - Phone:904-859-5654
Mailing Address - Fax:
Practice Address - Street 1:12620 BEACH BLVD STE 13
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7130
Practice Address - Country:US
Practice Address - Phone:904-633-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily