Healthcare Provider Details

I. General information

NPI: 1861232548
Provider Name (Legal Business Name): JEANETTE SORICELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9957 MOORINGS DR STE 301
JACKSONVILLE FL
32257-2415
US

IV. Provider business mailing address

14510 NEEDHAM DR
JACKSONVILLE FL
32256-0873
US

V. Phone/Fax

Practice location:
  • Phone: 904-652-6165
  • Fax: 833-241-4607
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: