Healthcare Provider Details

I. General information

NPI: 1134167687
Provider Name (Legal Business Name): JEAN HELEN MCCLINTOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14810 OLD SAINT AUGUSTINE RD STE 103
JACKSONVILLE FL
32258-2558
US

IV. Provider business mailing address

PO BOX 13834
TALLAHASSEE FL
32317-3834
US

V. Phone/Fax

Practice location:
  • Phone: 904-512-1899
  • Fax: 904-503-1052
Mailing address:
  • Phone: 904-512-1899
  • Fax: 904-503-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME71302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: