Provider Demographics
NPI:1538124706
Name:JEROME, FELICIA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:ANN
Last Name:JEROME
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 US 1 S STE 200
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5786
Mailing Address - Country:US
Mailing Address - Phone:904-494-2840
Mailing Address - Fax:904-829-6174
Practice Address - Street 1:1955 US 1 S STE 200
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5786
Practice Address - Country:US
Practice Address - Phone:904-494-2840
Practice Address - Fax:904-829-6174
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH75133Medicare UPIN
FL001569900Medicaid