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NPI Code Detail

MEDICARE: AQUILLA LYNETTE CRIBB

MEDICARE: AQUILLA LYNETTE CRIBB
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
1225100000XPhysical Therapist26506FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126506OTHERFLLICENSE

General Provider Information

NPI Number : 1538728498
Entity Type Code : Individual
Provider Name (Legal Business Name) : AQUILLA LYNETTE CRIBB
Provider Business Mailing Address
First Line : 7244 ANGELA DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32222-1936
Country : US
Telephone Number : 904-652-3791
Fax Number :
Provider Business Practice Location Address
First Line : 905 ASSISI LN
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32233-2972
Country : US
Telephone Number : 904-667-3660
Fax Number : 904-240-4429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2019
Last Update Date : 06/13/2019

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Directions to “ AQUILLA LYNETTE CRIBB ” Practice Location

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