Provider Demographics
NPI:1265749428
Name:JIROMA, INC
Entity type:Organization
Organization Name:JIROMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:WHITED
Authorized Official - Suffix:JR
Authorized Official - Credentials:ARNP, BC, LMT
Authorized Official - Phone:904-384-9007
Mailing Address - Street 1:PO BOX 380104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-0604
Mailing Address - Country:US
Mailing Address - Phone:904-384-9007
Mailing Address - Fax:
Practice Address - Street 1:1080 EDGEWOOD AVE S
Practice Address - Street 2:SUITE 7
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5393
Practice Address - Country:US
Practice Address - Phone:904-384-9007
Practice Address - Fax:904-384-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9279002163WR0400X, 174H00000X, 261QM1300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitationGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty