Healthcare Provider Details

I. General information

NPI: 1821514902
Provider Name (Legal Business Name): TAKE FLIGHT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR STE 1200
JACKSONVILLE FL
32207-8874
US

IV. Provider business mailing address

841 PRUDENTIAL DR. STE. 1200
JACKSONVILLE FL
32207
US

V. Phone/Fax

Practice location:
  • Phone: 866-585-1790
  • Fax:
Mailing address:
  • Phone: 866-585-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP006527
License Number StateNC

VIII. Authorized Official

Name: MS. WANDA RENFROW
Title or Position: SOCIAL WORKER CLINICAL/COUNSELOR
Credential: MSW
Phone: 404-630-9660