MEDICARE: JACKELINE VARGAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MT3659	FL

General Provider Information

NPI Number	:	1902759749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKELINE VARGAS

Provider Business Mailing Address
First Line	:	2853 EXECUTIVE PARK DR STE 101
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3656
Country	:	US
Telephone Number	:	954-800-2686
Fax Number	:	833-833-2414

Provider Business Practice Location Address
First Line	:	2853 EXECUTIVE PARK DR STE 101
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3656
Country	:	US
Telephone Number	:	954-800-2686
Fax Number	:	833-833-2414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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