Healthcare Provider Details

I. General information

NPI: 1164878435
Provider Name (Legal Business Name): FRANCES ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4856 CATHERINE TER
JACKSONVILLE FL
32205-7102
US

IV. Provider business mailing address

551 BAY HAWK CT
ORANGE PARK FL
32073-7673
US

V. Phone/Fax

Practice location:
  • Phone: 904-228-4637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-15-2002-26564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: