Individual
JACQUELYN MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1361 13TH AVE S STE 180, JACKSONVILLE BEACH, FL 32250-3235
(904) 247-4300
Mailing address
2001 KINGSLEY AVE, ORANGE PARK, FL 32073-5148
(904) 639-2000
(904) 639-2015
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS19989
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/19/2019
Last updated
07/03/2023
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