Individual
JEROME GREENFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13464 YELLOW BLUFF RD, JACKSONVILLE, FL 32226-3803
(904) 601-8846
Mailing address
13464 YELLOW BLUFF RD, JACKSONVILLE, FL 32226-3803
(904) 601-8846
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
G651439774020
FL
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G651-439-77-402-0
—
FL
Enumeration date
05/22/2017
Last updated
05/22/2017
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