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General NPI Number Information
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NPI Number | 1891662516
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Entity Type | Organization
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Legal Business Name | JTI PRINCIPAL MANAGEMENT INC
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 3547 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5309
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Country | US
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Telephone | 904-877-8882
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Fax | 904-877-1301
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Provider Business Mailing Address
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Address Line | 3547 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5309
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Country | US
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Telephone | 904-877-8882
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Fax | 904-877-1301
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Authorized Official
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Title or Position | CEO
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Name | MR. ZIAD AMIR YOUSSEF
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Credential |
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Telephone | 904-877-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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