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General NPI Number Information
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NPI Number | 1295659514
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Entity Type | Organization
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Legal Business Name | SKIN GLOW BEAUTY STUDIO LLC
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 10844 INDIES DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8843
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Country | US
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Telephone | 902-680-6717
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Fax |
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Provider Business Mailing Address
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Address Line | 635 CAMBRIDGE CT
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City | LONGWOOD
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State | FL
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Zip | 32750-3901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JAMES ERIC
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Credential |
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Telephone | 902-608-6717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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