Healthcare Provider Details

I. General information

NPI: 1811703564
Provider Name (Legal Business Name): NESERT ELLAINE PUENARY ASSOCIATE IN SCIENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2024
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9560 CROSSHILL BLVD STE 110
JACKSONVILLE FL
32222-5827
US

IV. Provider business mailing address

198 ARORA BLVD APT 1102
ORANGE PARK FL
32073-3282
US

V. Phone/Fax

Practice location:
  • Phone: 904-203-1296
  • Fax:
Mailing address:
  • Phone: 904-510-6241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA32602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: