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General NPI Number Information
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NPI Number | 1093389975
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Entity Type | Organization
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Legal Business Name | HYDRO INFUSIONS, LLC
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Dates
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Enumeration Date | 05/16/2021
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Last Update Date | 05/16/2021
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Provider Practice Location Address
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Address Line | 14797 PHILIPS HWY STE 201
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3746
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Country | US
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Telephone | 904-567-3998
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Fax | 904-567-5790
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Provider Business Mailing Address
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Address Line | 11 GRAY WOLF TRL
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City | PONTE VEDRA
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State | FL
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Zip | 32081-6052
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Country | US
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Telephone | 904-567-3998
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Fax | 904-567-5790
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Authorized Official
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Title or Position | MGR
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Name | DR. TRAVIS JEFFORDS
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Credential | DNP
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Telephone | 904-567-3998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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