Healthcare Provider Details

I. General information

NPI: 1427648948
Provider Name (Legal Business Name): JAMAICA HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9846 HWY 31 E
TYLER TX
75705-2329
US

IV. Provider business mailing address

9846 HWY 31 E
TYLER TX
75705-2329
US

V. Phone/Fax

Practice location:
  • Phone: 903-592-8001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number219841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: