Healthcare Provider Details

I. General information

NPI: 1760803373
Provider Name (Legal Business Name): MARIAN LAVONNE JONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CENTERHILL DR. NORTH
JACKSONVILLE FL
32254
US

IV. Provider business mailing address

3501 CENTERHILL DR. NORTH
JACKSONVILLE FL
32254
US

V. Phone/Fax

Practice location:
  • Phone: 904-683-8096
  • Fax:
Mailing address:
  • Phone: 904-683-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906429
License Number StateFL

VIII. Authorized Official

Name: MS. MARIAN LAVONNE JONES
Title or Position: PROVIDER
Credential:
Phone: 904-683-8096