Healthcare Provider Details

I. General information

NPI: 1124938568
Provider Name (Legal Business Name): MS. IMANI NATORI ELIZEBETH SCANTLEBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2392 EDGEWOOD AVE N
JACKSONVILLE FL
32254-1725
US

IV. Provider business mailing address

2392 EDGEWOOD AVE N
JACKSONVILLE FL
32254-1725
US

V. Phone/Fax

Practice location:
  • Phone: 904-781-7797
  • Fax: 904-781-8685
Mailing address:
  • Phone: 904-781-7797
  • Fax: 904-781-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: