Provider Demographics
NPI:1649003542
Name:JERIDO, CAMIKA S
Entity type:Individual
Prefix:
First Name:CAMIKA
Middle Name:S
Last Name:JERIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 LENOX AVE STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-4224
Mailing Address - Country:US
Mailing Address - Phone:904-566-9238
Mailing Address - Fax:
Practice Address - Street 1:3218 LENOX AVE STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-4224
Practice Address - Country:US
Practice Address - Phone:904-566-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL24000210814251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services