MEDICARE: YOUR JOURNEY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		FL

General Provider Information

NPI Number	:	1184631814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR JOURNEY INC.

Provider Business Mailing Address
First Line	:	9526 ARGYLE FOREST BLVD
Second Line	:	SUITE B2 PMB #309
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-2825
Country	:	US
Telephone Number	:	904-772-6442
Fax Number	:	904-772-6443

Provider Business Practice Location Address
First Line	:	9447 BRUNTSFIELD DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-7176
Country	:	US
Telephone Number	:	904-772-6442
Fax Number	:	904-772-6443

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LISA S. BLIZZARD
Credential	:	B.A.
Telephone Number	:	904-772-6442

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	08/22/2020

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Directions to “YOUR JOURNEY INC. ” Practice Location

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