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Contact Information

JEFFREY D RICKETTS, PA
836 PRUDENTIAL DR
STE 1804
JACKSONVILLE, FL32207
 Phone: 904-398-3888
 Fax: 904-400-6675
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for JEFFREY D RICKETTS · (Male)

NPI Number 1063495281
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 11/22/2005
Last updated 05/10/2018 - More than a year ago
Sole proprietor 1 No
Identifiers
  • FL License # PA9103298
  • FL Medicaid 292285100
Hospital affiliation(s)
  • BAPTIST MEDICAL CENTER - (Acute Care)
    800 PRUDENTIAL DR
    JACKSONVILLE, FL 32207
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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