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NPI Code Detail

MEDICARE: ISHMAEL EAVES FARRA MA

MEDICARE: ISHMAEL EAVES FARRA MA
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
1101Y00000XCounselor
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1336616382
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISHMAEL EAVES FARRA MA
Provider Business Mailing Address
First Line : 6639 SOUTHPOINT PKWY STE 108
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8042
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6639 SOUTHPOINT PKWY STE 108
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8042
Country : US
Telephone Number : 904-438-7640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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Directions to “ ISHMAEL EAVES FARRA MA” Practice Location

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