Provider Demographics
NPI:1609634047
Name:FREEMAN, JACQUELINE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:FREEMAN
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 1:103 CENTURY 21 DR STE 213
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-9295
Mailing Address - Country:US
Mailing Address - Phone:904-901-6144
Mailing Address - Fax:904-644-5450
Practice Address - Street 1:103 CENTURY 21 DR STE 213
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-9295
Practice Address - Country:US
Practice Address - Phone:904-901-6144
Practice Address - Fax:904-644-5450
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-0031R24246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy