Healthcare Provider Details

I. General information

NPI: 1265234629
Provider Name (Legal Business Name): JAIANA GAINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A: 12724 GRAN BAY PARKWAY WEST SUITE 410
JACKSONVILLE FL
32258-9486
US

IV. Provider business mailing address

606 MARION CT
DELAND FL
32720-3218
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 405-370-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: