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General NPI Number Information
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NPI Number | 1265749428
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Entity Type | Organization
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Legal Business Name | JIROMA, INC
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 1080 EDGEWOOD AVE S SUITE 7
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City | JACKSONVILLE
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State | FL
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Zip | 32205-5393
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Country | US
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Telephone | 904-384-9007
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Fax | 904-384-2899
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Provider Business Mailing Address
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Address Line | PO BOX 380104
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City | JACKSONVILLE
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State | FL
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Zip | 32205-0604
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Country | US
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Telephone | 904-384-9007
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES CARLTON WHITED JR.
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Credential | ARNP, BC, LMT
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Telephone | 904-384-9007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0400X
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Taxonomy Name | Rehabilitation Registered Nurse
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License Number | 9279002
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 9279002
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 9279002
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9279002
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License Number State | FL
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