Healthcare Provider Details

I. General information

NPI: 1003244823
Provider Name (Legal Business Name): ANNIE CAROL MONROE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8372 COUNTRY CREEK BLVD
JACKSONVILLE FL
32221-6685
US

IV. Provider business mailing address

8372 COUNTRY CREEK BLVD
JACKSONVILLE FL
32221-6685
US

V. Phone/Fax

Practice location:
  • Phone: 904-783-9448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNIE CAROL MONROE
Title or Position: OWNER
Credential:
Phone: 904-783-9448