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General NPI Number Information
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NPI Number | 1396023131
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE DENTAL AND MEDICAL TEMP AGENCY
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 07/27/2011
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Provider Practice Location Address
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Address Line | 421 LABARRE CT
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City | SAINT JOHNS
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State | FL
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Zip | 32259-4024
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Country | US
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Telephone | 904-803-0617
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Fax |
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Provider Business Mailing Address
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Address Line | 12276 SAN JOSE BLVD BUILDING 500 SUITE 518
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8628
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Country | US
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Telephone | 904-268-9988
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Fax | 904-268-9922
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. WANDA JEAN JONES
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Credential |
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Telephone | 904-803-0617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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