Healthcare Provider Details

I. General information

NPI: 1386357556
Provider Name (Legal Business Name): JEROME MINCEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7775 BAYMEADOWS WAY STE 200
JACKSONVILLE FL
32256-7531
US

IV. Provider business mailing address

8681 STAR LEAF RD N
JACKSONVILLE FL
32210-9639
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-2199
  • Fax:
Mailing address:
  • Phone: 904-571-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: