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General NPI Number Information
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NPI Number | 1104662535
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Entity Type | Organization
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Legal Business Name | JAX NORA ONE LLC
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Dates
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Enumeration Date | 07/04/2024
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Last Update Date | 07/04/2024
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Provider Practice Location Address
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Address Line | 8144 SUMMIT RIDGE LN
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7149
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Country | US
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Telephone | 904-945-9054
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Fax |
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Provider Business Mailing Address
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Address Line | 8144 SUMMIT RIDGE LN
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7149
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Country | US
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Telephone | 904-945-9054
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICAL
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Name | SCOTT NELOWET
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Credential |
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Telephone | 904-945-9054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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