Provider Demographics
NPI:1235596461
Name:FREEMAN, JACQUELYN (PA)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:STEMBRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4205 BELFORT RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5876
Mailing Address - Country:US
Mailing Address - Phone:904-450-6300
Mailing Address - Fax:
Practice Address - Street 1:4205 BELFORT RD STE 1100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-450-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016547300Medicaid
FLL5T3NOtherFLORIDA BLUE
FLIM393YMedicare PIN