MEDICARE: JOANN MCFADDEN

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	376K00000X	Nurse's Aide	CNA128700	FL

General Provider Information

NPI Number	:	1952095804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN MCFADDEN

Provider Business Mailing Address
First Line	:	9363 HAWKS POINT DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-2819
Country	:	US
Telephone Number	:	904-401-3116
Fax Number	:

Provider Business Practice Location Address
First Line	:	9363 HAWKS POINT DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-2819
Country	:	US
Telephone Number	:	904-401-3116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	12/07/2023

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