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General NPI Number Information
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NPI Number | 1316482805
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Entity Type | Organization
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Legal Business Name | RED SAGE ACUPUNCTURE LLC
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 4741 ATLANTIC BLVD STE E2
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City | JACKSONVILLE
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State | FL
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Zip | 32207-1138
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Country | US
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Telephone | 904-572-7929
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Fax |
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Provider Business Mailing Address
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Address Line | 4741 ATLANTIC BLVD STE E2
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City | JACKSONVILLE
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State | FL
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Zip | 32207-1138
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Country | US
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Telephone | 904-572-7929
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JANN WHIDDEN TURPIN
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Credential |
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Telephone | 904-572-7929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP3093
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License Number State | FL
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