Provider Demographics
NPI:1902958184
Name:SEARS, GENEVIEVE JOHNSON (PA-C)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:JOHNSON
Last Name:SEARS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:ALICE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:2377 DUNN AVE
Practice Address - Street 2:UFJAX - DUNN AVENUE FAMILY PRACTICE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6983
Practice Address - Country:US
Practice Address - Phone:904-633-0700
Practice Address - Fax:904-633-0701
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2927713-00Medicaid
FLAC732YMedicare PIN