Healthcare Provider Details

I. General information

NPI: 1093444218
Provider Name (Legal Business Name): ADDISBELL ESPINOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WELLS RD
ORANGE PARK FL
32073-3035
US

IV. Provider business mailing address

7846 VALLEYVIEW DR
JACKSONVILLE FL
32211-4951
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-3522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: