Provider Demographics
NPI:1033924642
Name:MUMIA, JACKLINE LINDA (PMNP-BC)
Entity type:Individual
Prefix:
First Name:JACKLINE
Middle Name:LINDA
Last Name:MUMIA
Suffix:
Gender:F
Credentials:PMNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 JULIA MARIE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-0412
Mailing Address - Country:US
Mailing Address - Phone:904-428-3649
Mailing Address - Fax:
Practice Address - Street 1:4500 SALISBURY RD STE 490
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0968
Practice Address - Country:US
Practice Address - Phone:904-562-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036814363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty