Healthcare Provider Details

I. General information

NPI: 1972141224
Provider Name (Legal Business Name): AMI B KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8161 CROSSWIND RD
JACKSONVILLE FL
32244-5453
US

IV. Provider business mailing address

8161 CROSSWIND RD
JACKSONVILLE FL
32244-5453
US

V. Phone/Fax

Practice location:
  • Phone: 904-646-8887
  • Fax:
Mailing address:
  • Phone: 904-646-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: