Healthcare Provider Details

I. General information

NPI: 1053879437
Provider Name (Legal Business Name): HEALTHLETIX MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 SUNBEAM RD STE 7
JACKSONVILLE FL
32257-8931
US

IV. Provider business mailing address

3948 SUNBEAM RD STE 7
JACKSONVILLE FL
32257-8931
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-1190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE LISIECKI
Title or Position: BUSINESS MANAGER
Credential:
Phone: 904-268-1190