Provider Demographics
NPI:1992174627
Name:GOLDEN, JACINDA (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:JACINDA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 PARK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5558
Mailing Address - Country:US
Mailing Address - Phone:904-203-8559
Mailing Address - Fax:904-592-5282
Practice Address - Street 1:2301 PARK AVE STE 203
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5558
Practice Address - Country:US
Practice Address - Phone:904-203-8559
Practice Address - Fax:904-592-5282
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW315176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101369900Medicaid