Provider Demographics
NPI:1548929334
Name:JARDINE WELLNESS LLC
Entity type:Organization
Organization Name:JARDINE WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:727-241-5504
Mailing Address - Street 1:333 3RD AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3899
Mailing Address - Country:US
Mailing Address - Phone:727-241-5504
Mailing Address - Fax:
Practice Address - Street 1:333 3RD AVE N STE 400
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3899
Practice Address - Country:US
Practice Address - Phone:727-241-5504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty