Provider Demographics
NPI:1548082316
Name:COX, JACQUELINE ERICA (MED/EDS)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ERICA
Last Name:COX
Suffix:
Gender:F
Credentials:MED/EDS
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ERICA
Other - Last Name:KLOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED/EDS
Mailing Address - Street 1:320 S STATE ROAD 19
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3939
Mailing Address - Country:US
Mailing Address - Phone:904-615-7570
Mailing Address - Fax:
Practice Address - Street 1:320 S STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3939
Practice Address - Country:US
Practice Address - Phone:904-615-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health