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5011 Gate Parkway Bldg 100, Suite 100 Jacksonville FL 32256 | |
| (305) 783-3991 | |
| (305) 230-7616 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 5011 Gate Parkway, Jacksonville, Florida |
| Authorized Official Name and Position | Jessica Kuilan (CEO) |
| Authorized Official Contact | 3057833991 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5011 Gate Parkway Bldg 100 Suite 100 Jacksonville FL 32256-0830 Ph: (305) 439-6969 | 5011 Gate Parkway Bldg 100, Suite 100 Jacksonville FL 32256 Ph: (305) 783-3991 |
| NPI Number | 1154823466 |
|---|---|
| Provider Enumeration Date | 03/02/2018 |
| Last Update Date | 01/18/2020 |
| Certification Date | 01/18/2020 |
| Medicare PECOS PAC ID | 3072853407 |
|---|---|
| Medicare Enrollment ID | O20190322000066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154823466 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW13911 (Florida) | Primary |
| 251B00000X | Case Management | (* (Not Available)) | Secondary |
| Provider Name | Jessica Lizbeth Kuilan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427506658 PECOS PAC ID: 2062752496 Enrollment ID: I20190322000105 |
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