Provider Demographics
NPI:1275005597
Name:FLOYD, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 WILD DUNES CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2621
Mailing Address - Country:US
Mailing Address - Phone:904-885-8085
Mailing Address - Fax:
Practice Address - Street 1:5345 ORTEGA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8443
Practice Address - Country:US
Practice Address - Phone:904-413-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health