Healthcare Provider Details

I. General information

NPI: 1548049018
Provider Name (Legal Business Name): MOBILEBIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TOWNSEND BLVD BLDG APT 240
JACKSONVILLE FL
32277-9303
US

IV. Provider business mailing address

PO BOX 43276
JACKSONVILLE FL
32203-3276
US

V. Phone/Fax

Practice location:
  • Phone: 251-513-4228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISHAYIA BRANSON
Title or Position: OWNER
Credential:
Phone: 251-513-4228