Healthcare Provider Details

I. General information

NPI: 1285546812
Provider Name (Legal Business Name): JAIMYA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 FOURAKER RD APT 5410
JACKSONVILLE FL
32221-7695
US

IV. Provider business mailing address

1485 FOURAKER RD APT 5410
JACKSONVILLE FL
32221-7695
US

V. Phone/Fax

Practice location:
  • Phone: 904-916-3793
  • Fax:
Mailing address:
  • Phone: 904-916-3793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number491717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: