Healthcare Provider Details

I. General information

NPI: 1821500455
Provider Name (Legal Business Name): JENNIFER MAIDER STONE LM, CPM, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2017
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 JORK RD STE 301
JACKSONVILLE FL
32207-2494
US

IV. Provider business mailing address

2301 PARK AVE STE 203
ORANGE PARK FL
32073-5558
US

V. Phone/Fax

Practice location:
  • Phone: 904-203-8559
  • Fax: 904-592-5282
Mailing address:
  • Phone: 904-203-8559
  • Fax: 904-592-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5190640
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: