Provider Demographics
NPI:1295406478
Name:FOX, JADA LYNNE (MA)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:LYNNE
Last Name:FOX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 CHATHAM CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-5191
Mailing Address - Country:US
Mailing Address - Phone:708-378-3831
Mailing Address - Fax:
Practice Address - Street 1:2572 CHATHAM CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5191
Practice Address - Country:US
Practice Address - Phone:708-378-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver