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General NPI Number Information
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NPI Number | 1073497608
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Entity Type | Organization
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Legal Business Name | EDUCATION TRANSFORMATION ENTERPRISES INC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 767 BLANDING BLVD STE 110B
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City | ORANGE PARK
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State | FL
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Zip | 32065-5788
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Country | US
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Telephone | 904-539-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 767 BLANDING BLVD STE 110B
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City | ORANGE PARK
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State | FL
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Zip | 32065-5788
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Country | US
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Telephone | 904-539-8300
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KRISTAL TODD
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Credential | FLDOE TEACHER
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Telephone | 904-539-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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