Healthcare Provider Details

I. General information

NPI: 1134084833
Provider Name (Legal Business Name): PETRONIA D IVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8032 MACNAUGHTON DR
JACKSONVILLE FL
32244-5589
US

IV. Provider business mailing address

8032 MACNAUGHTON DR
JACKSONVILLE FL
32244-5589
US

V. Phone/Fax

Practice location:
  • Phone: 904-333-8906
  • Fax:
Mailing address:
  • Phone: 904-333-8906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: