Healthcare Provider Details

I. General information

NPI: 1851969679
Provider Name (Legal Business Name): MIRACLE HEARTS & HANDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BAY ST STE 1400
JACKSONVILLE FL
32202-5100
US

IV. Provider business mailing address

301 W BAY ST STE 1400
JACKSONVILLE FL
32202-5100
US

V. Phone/Fax

Practice location:
  • Phone: 904-274-5784
  • Fax:
Mailing address:
  • Phone: 904-274-5784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTI KINDELL
Title or Position: CEO
Credential:
Phone: 912-275-3549