Healthcare Provider Details

I. General information

NPI: 1164971917
Provider Name (Legal Business Name): JACINDA GOLDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9439 SAN JOSE BLVD APT 3
JACKSONVILLE FL
32257-9233
US

IV. Provider business mailing address

9439 SAN JOSE BLVD APT 3
JACKSONVILLE FL
32257-9233
US

V. Phone/Fax

Practice location:
  • Phone: 904-505-4848
  • Fax: 904-339-9335
Mailing address:
  • Phone: 904-505-4848
  • Fax: 904-339-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW315
License Number StateFL

VIII. Authorized Official

Name: JACINDA GOLDEN
Title or Position: SOLE PROPRIETOR
Credential: LM, CPM
Phone: 904-505-4848