Healthcare Provider Details

I. General information

NPI: 1265348650
Provider Name (Legal Business Name): MADELINE ELISE JUBRAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12443 SAN JOSE BLVD STE 204
JACKSONVILLE FL
32223-8648
US

IV. Provider business mailing address

3638 HOLLY GROVE AVE
JACKSONVILLE FL
32217-4234
US

V. Phone/Fax

Practice location:
  • Phone: 904-432-3321
  • Fax:
Mailing address:
  • Phone: 904-304-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: