Healthcare Provider Details

I. General information

NPI: 1609077544
Provider Name (Legal Business Name): MS. EVELYN D NORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DRIVE NORTH SUITE 101
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

6867 SOUTHPOINT DRIVE NORTH SUITE 101
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax: 904-212-0309
Mailing address:
  • Phone: 904-226-1297
  • Fax: 904-262-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: