Healthcare Provider Details

I. General information

NPI: 1205286325
Provider Name (Legal Business Name): JOSIE M MAIONE-MCMAHON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR STE 1400
JACKSONVILLE FL
32207-8364
US

IV. Provider business mailing address

4354 MELROSE AVE
JACKSONVILLE FL
32210-2133
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-5682
  • Fax:
Mailing address:
  • Phone: 937-672-0998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME134476
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME134476
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.150060
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: