Male or Other

John M. Tierney PA

Physician Assistant in Jacksonville, FL(View on Map)

Full Name

John Michael Tierney PA

NPI Number

1124023445

NPI Type

Individual Provider

Gender

Male

Enumeration Date

06/14/2005

Specialties

(Taxonomies)

Code

363A00000X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

PA9102882

Contact
Information

Purpose

Mailing
Location

Address

1325 SAN MARCO BLVD STE 200
14540 OLD SAINT AUGUSTINE RD

City

Jacksonville
Jacksonville

State

FL
FL

Postal Code

32207-8566
32258-7418

Country

US
US

Telephone Number

(904) 346-3465
(904) 880-1260

Identifiers

Identifier

292014000

Identifier State

FL

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 11/19/2015

Provider Address

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