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General NPI Number Information
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NPI Number | 1255120895
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Entity Type | Individual
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Provider Name | ELTOYA HUMPHRIES
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Gender | Female
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1998 PATRIOT WALK DR
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City | JACKSONVILLE
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State | FL
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Zip | 32221-5614
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Country | US
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Telephone | 904-887-0507
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Fax |
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Provider Business Mailing Address
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Address Line | 1998 PATRIOT WALK DR
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City | JACKSONVILLE
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State | FL
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Zip | 32221-5614
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Country | US
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Telephone | 904-887-0507
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9301053
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License Number State | FL
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