Healthcare Provider Details

I. General information

NPI: 1538309877
Provider Name (Legal Business Name): AHLAN M JAMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR UNIT 1410
JACKSONVILLE FL
32207-8364
US

IV. Provider business mailing address

841 PRUDENTIAL DR UNIT 1410
JACKSONVILLE FL
32207-8364
US

V. Phone/Fax

Practice location:
  • Phone: 904-373-5304
  • Fax:
Mailing address:
  • Phone: 904-373-5304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME135824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: