Healthcare Provider Details

I. General information

NPI: 1598684904
Provider Name (Legal Business Name): MRS. JESSICA MARIE MUNIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13553 ATLANTIC BLVD STE 100
JACKSONVILLE FL
32225-4227
US

IV. Provider business mailing address

4090 HODGES BLVD APT 813
JACKSONVILLE FL
32224-4209
US

V. Phone/Fax

Practice location:
  • Phone: 904-420-7030
  • Fax:
Mailing address:
  • Phone: 904-292-7545
  • 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: