Healthcare Provider Details

I. General information

NPI: 1205772092
Provider Name (Legal Business Name): JAKE MCCLINTON STRONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 W 20TH AVE
HIALEAH FL
33012-5826
US

IV. Provider business mailing address

2030 N 29TH AVE APT 307
HOLLYWOOD FL
33020-1736
US

V. Phone/Fax

Practice location:
  • Phone: 786-828-7552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: