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General NPI Number Information
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NPI Number | 1154928554
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Entity Type | Individual
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Provider Name | JIMEI HE DOM
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Gender | Female
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 24842 BLAZING TRAIL WAY
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City | LAND O LAKES
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State | FL
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Zip | 34639-9584
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Country | US
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Telephone | 813-943-9231
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Fax |
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Provider Business Mailing Address
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Address Line | 24842 BLAZING TRAIL WAY
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City | LAND O LAKES
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State | FL
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Zip | 34639-9584
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Country | US
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Telephone | 813-943-9231
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS34516
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP4171
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License Number State | FL
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