Healthcare Provider Details

I. General information

NPI: 1093138646
Provider Name (Legal Business Name): TIA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 SW AMBERWOOD LOOP APT 104
LAKE CITY FL
32025
US

IV. Provider business mailing address

648 SW AMBERWOOD LOOP APT 104
LAKE CITY FL
32025
US

V. Phone/Fax

Practice location:
  • Phone: 386-688-3277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: