Provider Demographics
NPI:1003585639
Name:PAUGAM, JAMIE DESIREE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DESIREE
Last Name:PAUGAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 RIVER RD APT 16
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-1038
Mailing Address - Country:US
Mailing Address - Phone:786-647-0234
Mailing Address - Fax:
Practice Address - Street 1:1656 RIVER RD APT 16
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-1038
Practice Address - Country:US
Practice Address - Phone:786-647-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA90937225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist