Provider Demographics
NPI:1528169612
Name:JOHNSTON, JAY HUNTER (PA-C)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:HUNTER
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4885
Mailing Address - Country:US
Mailing Address - Phone:772-778-2009
Mailing Address - Fax:772-778-2910
Practice Address - Street 1:2402 FRIST BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-462-3939
Practice Address - Fax:772-462-3938
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292562100Medicaid
FLAB623ZMedicare PIN
FL1272290001Medicare NSC