Provider Demographics
NPI:1508262874
Name:JACKSONVILLE MANAGEMENT AND STAFFING
Entity Type:Organization
Organization Name:JACKSONVILLE MANAGEMENT AND STAFFING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOPRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-300-4820
Mailing Address - Street 1:445 8TH AVE N
Mailing Address - Street 2:B
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5760
Mailing Address - Country:US
Mailing Address - Phone:203-300-4820
Mailing Address - Fax:
Practice Address - Street 1:13500 SUTTON PARK DR S
Practice Address - Street 2:403
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5251
Practice Address - Country:US
Practice Address - Phone:904-400-5703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X, 251F00000X, 251G00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based