Provider Demographics
NPI:1295749968
Name:MIRABILE, JEREMY SHAWN (MD ABPM-ADM, FASAM)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SHAWN
Last Name:MIRABILE
Suffix:
Gender:M
Credentials:MD ABPM-ADM, FASAM
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Mailing Address - Street 1:1030 A1A N
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4019
Mailing Address - Country:US
Mailing Address - Phone:904-551-1394
Mailing Address - Fax:888-770-4284
Practice Address - Street 1:1030 A1A N
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4019
Practice Address - Country:US
Practice Address - Phone:904-551-1394
Practice Address - Fax:888-770-4284
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME88707207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine