Healthcare Provider Details

I. General information

NPI: 1457331415
Provider Name (Legal Business Name): JING-JING MAMABA CARDONA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 FORTUNE PKWY UNIT 1101
JACKSONVILLE FL
32256-6757
US

IV. Provider business mailing address

10175 FORTUNE PKWY UNIT 1101
JACKSONVILLE FL
32256-6757
US

V. Phone/Fax

Practice location:
  • Phone: 904-551-4625
  • Fax: 904-990-1491
Mailing address:
  • Phone: 904-551-4625
  • Fax: 904-990-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number89992241
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME111613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: