Provider Demographics
NPI:1760856983
Name:JONES, JAY
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:JONES
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 1:1609 TIMBER PINES CT
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7974
Mailing Address - Country:US
Mailing Address - Phone:407-925-4733
Mailing Address - Fax:
Practice Address - Street 1:1609 TIMBER PINES CT
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7974
Practice Address - Country:US
Practice Address - Phone:407-925-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS 4756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist