Laurel Elizabeth Herron, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101706 Issued in FL

Practice address

11761 Beach Blvd
Ufjax - St. Johns Bluff Primary Care
Jacksonville, FL 32246-6615

Phone

(904) 633-0585

Fax

(904) 633-0586

NPI assigned

Mar 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453766400000",
    "number": "1083681357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "address_2": "UFJP PROVIDER ENROLLMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008",
            "telephone_number": "904-244-3199",
            "fax_number": "904-244-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11761 BEACH BLVD",
            "address_2": "UFJAX - ST. JOHNS BLUFF PRIMARY CARE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322466615",
            "telephone_number": "904-633-0585",
            "fax_number": "904-633-0586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRON",
        "first_name": "LAUREL",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-04",
        "last_updated": "2016-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2911078-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isaac H Herring, MA
• Leonard Jay Herring, PA-C
• Maroliny S Herring
• Tatiana Herring
• Sarah Herrington
• Robyn M Hershberger, SLP
• Ryan Allen Hershey, DDS
• Theresa Marie Hershfield, NP
• Ana P Hert, BCABA
• Cassandra Hert

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.