MEDICARE: JACKELINE CUEVAS PEREZ BA

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	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1952927881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKELINE CUEVAS PEREZ BA

Provider Business Mailing Address
First Line	:	3378 BARINA ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-5633
Country	:	US
Telephone Number	:	787-505-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	3378 BARINA ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-5633
Country	:	US
Telephone Number	:	787-505-1090
Fax Number	:

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

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	06/13/2024

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