Provider Demographics
NPI:1972362226
Name:GILMORE, JACQUELINE RODRIGUEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:RODRIGUEZ
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 PARK AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5573
Mailing Address - Country:US
Mailing Address - Phone:904-272-0384
Mailing Address - Fax:
Practice Address - Street 1:2300 PARK AVE STE 205
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5573
Practice Address - Country:US
Practice Address - Phone:904-272-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty