Provider Demographics
NPI:1235661562
Name:JACO, JAMES PAUL (MED)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PAUL
Last Name:JACO
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 25TH STREET CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4927
Mailing Address - Country:US
Mailing Address - Phone:419-930-7030
Mailing Address - Fax:
Practice Address - Street 1:5630 25TH STREET CIR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4927
Practice Address - Country:US
Practice Address - Phone:419-930-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician