Provider Demographics
NPI:1114737178
Name:JUMPSTART PEDIATRICS
Entity type:Organization
Organization Name:JUMPSTART PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-710-0437
Mailing Address - Street 1:3901 UNIVERSITY BLVD S STE 125
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4375
Mailing Address - Country:US
Mailing Address - Phone:904-683-4355
Mailing Address - Fax:904-683-7089
Practice Address - Street 1:7207 GOLDEN WINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-3324
Practice Address - Country:US
Practice Address - Phone:904-710-0437
Practice Address - Fax:904-475-2706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIS-MOORE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric