Provider Demographics
NPI:1396855813
Name:BRACY, JUANITA DENAE (PA-C, MPA, ATC, MED)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:DENAE
Last Name:BRACY
Suffix:
Gender:F
Credentials:PA-C, MPA, ATC, MED
Other - Prefix:MS
Other - First Name:JUANITA
Other - Middle Name:DENAE
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:6800 SOUTHPOINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8203
Mailing Address - Country:US
Mailing Address - Phone:904-634-0640
Mailing Address - Fax:904-634-0203
Practice Address - Street 1:3055 COUNTY ROAD 210 W STE 110
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7001
Practice Address - Country:US
Practice Address - Phone:214-580-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0120008642255A2300X
CA2255A2300X
NC306479363AM0700X
CAPA60497363AM0700X
363AM0700X
TXPA15256363AM0700X
FLPA9118228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0070402592OtherNATA BOC
VA0126000864OtherATC VIRGINIA LICENSE
TXPA15256Medicaid