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Johanna Leigh Chan

Internal Medicine

Allopathic & Osteopathic Physicians

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

PECOS Enrollment

This provider is enrolled in PECOS as JOHANNA CHAN.

Based on the most recent information from CMS, provider Johanna Leigh Chan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1679716096
Provider Type
Individual
Full Name
Chan, Johanna Leigh
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
4/15/2009
Last Updated
9/16/2021

Contact Information

Practice Location

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Mailing Location

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207RG0100X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 151626 Florida
Code 207RG0100X	Description Internal Medicine Allopathic & Osteopathic Physicians	License Q5635 Texas
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Johanna Leigh Chan

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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Laoveeravat, Passisd

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Cangemi, John

Riegert-Johnson, Douglas

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Yang, Liu

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Eluri, Swathi

Sulbaran Nava, Marianny Nazareth