Individual ProviderJason RunyanNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address13927 Shipwreck Cir N, Jacksonville, FL 32224-1121(904) 570-9404PECOS EnrollmentBased on the most recent information from CMS, provider Jason Runyan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 1:10 PM.Profile DetailsProvider ID1821123803Provider TypeIndividualFull NameRunyan, JasonCredentialNPGenderMaleSole ProprietorNoEnumeration Date2/22/2007Last Updated4/11/2017Contact InformationPractice LocationPractice Address13927 Shipwreck Cir N, Jacksonville, FL 32224-1121Phone(904) 570-9404Fax(904) 379-9332Mailing LocationMailing Address13927 Shipwreck Cir N, Jacksonville, FL 32224-1121Phone(904) 570-9404Fax(904) 379-9332Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseARNP9334592FloridaCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense4425PKentuckyProvider IdentifiersIDDescriptionIssuerID000000548409DescriptionOtherIssuerBCBSID3548051000DescriptionOtherIssuerPASSPORT ADVANTAGEKentucky