Healthcare Provider Details

I. General information

NPI: 1629985437
Provider Name (Legal Business Name): JAES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RAINIER LN STE 10
SAINT JOHNS FL
32259-3091
US

IV. Provider business mailing address

279 CREEKMORE DR
SAINT AUGUSTINE FL
32092-3251
US

V. Phone/Fax

Practice location:
  • Phone: 786-202-9024
  • Fax:
Mailing address:
  • Phone: 904-247-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALINA COLEMAN
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 904-247-3320