| Jax's Family Care And Research Center, P.a. | |
|
5233 Ricker Rd Ste 101 Jacksonville FL 32210 | |
| (904) 800-2332 | |
| (904) 634-7892 |
| Full Name | Jax's Family Care And Research Center, P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5233 Ricker Rd Ste 101, Jacksonville, Florida |
| Authorized Official Name and Position | Jairo Antonio Delahoz (MANAGER) |
| Authorized Official Contact | 9048002332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jax's Family Care And Research Center, P.a. 5233 Ricker Rd Ste 101 Jacksonville FL 32210-1439 Ph: (904) 800-2332 | Jax's Family Care And Research Center, P.a. 5233 Ricker Rd Ste 101 Jacksonville FL 32210 Ph: (904) 800-2332 |
| NPI Number | 1275704710 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 07/11/2018 |
| Medicare PECOS PAC ID | 5890731434 |
|---|---|
| Medicare Enrollment ID | O20180706000845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275704710 | NPI | - | NPPES |
| 251739600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ME70797 (Florida) | Primary |
| Provider Name | Jairo A De La Hoz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972528545 PECOS PAC ID: 7911967971 Enrollment ID: I20050706001117 |
| Provider Name | Natosha Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265689681 PECOS PAC ID: 5597944413 Enrollment ID: I20110125000484 |
| Provider Name | Raquel Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790223386 PECOS PAC ID: 9931485711 Enrollment ID: I20170410001556 |
| Provider Name | Rosangelly Colon-torres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568097129 PECOS PAC ID: 6002226883 Enrollment ID: I20201105002422 |
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