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General NPI Number Information
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NPI Number | 1609634047
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Entity Type | Individual
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Provider Name | MRS. JACQUELINE FREEMAN
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Gender | Female
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 103 CENTURY 21 DR STE 213
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City | JACKSONVILLE
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State | FL
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Zip | 32216-9295
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Country | US
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Telephone | 904-901-6144
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Fax | 904-644-5450
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Provider Business Mailing Address
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Address Line | 103 CENTURY 21 DR STE 213
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City | JACKSONVILLE
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State | FL
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Zip | 32216-9295
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Country | US
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Telephone | 904-901-6144
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Fax | 904-644-5450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 20-0031R24
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License Number State | FL
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