Provider Demographics
NPI:1316821044
Name:JAXOMS, P.A.
Entity type:Organization
Organization Name:JAXOMS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-483-1919
Mailing Address - Street 1:14453 BEACH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2081
Mailing Address - Country:US
Mailing Address - Phone:904-821-1334
Mailing Address - Fax:
Practice Address - Street 1:14453 BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2081
Practice Address - Country:US
Practice Address - Phone:904-821-1334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty