Healthcare Provider Details

I. General information

NPI: 1063281327
Provider Name (Legal Business Name): JADE MADISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11246 ALUMNI WAY
JACKSONVILLE FL
32246-6688
US

IV. Provider business mailing address

11246 ALUMNI WAY
JACKSONVILLE FL
32246-6688
US

V. Phone/Fax

Practice location:
  • Phone: 904-454-3964
  • Fax: 904-800-1444
Mailing address:
  • Phone: 904-454-3964
  • Fax: 904-800-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-262423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: