Healthcare Provider Details

I. General information

NPI: 1255304952
Provider Name (Legal Business Name): LAVOSHIA DEON MCCRACKEN CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

1756 CHANDELIER CIR W
JACKSONVILLE FL
32225-5554
US

V. Phone/Fax

Practice location:
  • Phone: 904-228-0812
  • Fax:
Mailing address:
  • Phone: 904-379-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: