Healthcare Provider Details

I. General information

NPI: 1134321664
Provider Name (Legal Business Name): JHARMAN LIGHTNER M.S.,ITDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JHARMAN FOSTER M.S., ITDS

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 W UNION ST
JACKSONVILLE FL
32202-4047
US

IV. Provider business mailing address

PO BOX 65516
ORANGE PARK FL
32065-0009
US

V. Phone/Fax

Practice location:
  • Phone: 904-595-6516
  • Fax:
Mailing address:
  • Phone: 904-595-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: