Provider Demographics
NPI:1679059893
Name:ALLEN, JONICA JADE (MSN, FNP-BC, OCN)
Entity type:Individual
Prefix:MISS
First Name:JONICA
Middle Name:JADE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSN, FNP-BC, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 ARREDONDO GRANT RD
Mailing Address - Street 2:
Mailing Address - City:DE LEON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32130-3703
Mailing Address - Country:US
Mailing Address - Phone:386-804-8581
Mailing Address - Fax:
Practice Address - Street 1:325 CLYDE MORRIS BLVD STE 450
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8179
Practice Address - Country:US
Practice Address - Phone:386-673-2442
Practice Address - Fax:386-673-2442
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9325795363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily