Provider Demographics
NPI:1063007599
Name:JONES, JACINDA Y
Entity Type:Individual
Prefix:
First Name:JACINDA
Middle Name:Y
Last Name:JONES
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 1:3120 FORT SOCRUM VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-0321
Mailing Address - Country:US
Mailing Address - Phone:863-944-2219
Mailing Address - Fax:
Practice Address - Street 1:3120 FORT SOCRUM VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-0321
Practice Address - Country:US
Practice Address - Phone:863-944-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care