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General NPI Number Information
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NPI Number | 1346733185
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Entity Type | Organization
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Legal Business Name | DUESEASON1
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 4058 SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32207
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Country | US
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Telephone | 904-504-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 731 DUVAL STATION RD STE 107
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City | JACKSONVILLE
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State | FL
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Zip | 32218-0801
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Country | US
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Telephone | 904-504-8855
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Fax | 904-683-9670
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Authorized Official
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Title or Position | MEMBER
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Name | TONYA HALL
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Credential |
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Telephone | 904-504-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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