Provider Demographics
NPI:1629794094
Name:BUIE, JALIN DEMONTE
Entity Type:Individual
Prefix:
First Name:JALIN
Middle Name:DEMONTE
Last Name:BUIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7963 DELTA POST DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6834
Mailing Address - Country:US
Mailing Address - Phone:904-327-4067
Mailing Address - Fax:
Practice Address - Street 1:7963 DELTA POST DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6834
Practice Address - Country:US
Practice Address - Phone:904-327-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health