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General NPI Number Information
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NPI Number | 1164870101
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Entity Type | Individual
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Provider Name | JACQUELINE JAMES
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Gender | Female
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 3947 WARBLER DR
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City | WINTER HAVEN
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State | FL
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Zip | 33880-5034
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Country | US
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Telephone | 352-301-1778
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Fax | 863-875-6806
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Provider Business Mailing Address
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Address Line | 1579 NORMANDY HEIGHTS BLVD
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City | WINTER HAVEN
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State | FL
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Zip | 33880-5324
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Country | US
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Telephone | 352-301-1778
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Fax | 863-875-6806
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 234446
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 253ZOOOOOX
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License Number State | FL
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