Healthcare Provider Details

I. General information

NPI: 1205765013
Provider Name (Legal Business Name): HEBAH ZAHI NIJEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GATEWAY CIR
ST JOHNS FL
32259-4084
US

IV. Provider business mailing address

7071 DEER LODGE CIR UNIT 104
JACKSONVILLE FL
32256-8511
US

V. Phone/Fax

Practice location:
  • Phone: 904-893-3237
  • Fax:
Mailing address:
  • Phone: 904-333-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: