Provider Demographics
NPI:1639440415
Name:JEIFEZ-ZAGAGI, KARINA ANDREA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARINA
Middle Name:ANDREA
Last Name:JEIFEZ-ZAGAGI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:1650 PRUDENTIAL DR
Practice Address - Street 2:SUITE 210
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8147
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-396-8966
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8339103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGZ059ZMedicare PIN