Healthcare Provider Details

I. General information

NPI: 1396291266
Provider Name (Legal Business Name): MS. PAMELA WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 TAMMY COVE LN
JACKSONVILLE FL
32218-7646
US

IV. Provider business mailing address

832 TAMMY COVE LN
JACKSONVILLE FL
32218-7646
US

V. Phone/Fax

Practice location:
  • Phone: 904-386-3465
  • Fax:
Mailing address:
  • Phone: 904-386-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: