Healthcare Provider Details

I. General information

NPI: 1013540129
Provider Name (Legal Business Name): JACQUELINE SERLETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 1602
JACKSONVILLE FL
32216-6298
US

IV. Provider business mailing address

1644 SUMMERDOWN WAY
JACKSONVILLE FL
32259-6241
US

V. Phone/Fax

Practice location:
  • Phone: 919-247-2450
  • Fax: 904-379-0113
Mailing address:
  • Phone: 678-371-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA17231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: