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General NPI Number Information
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NPI Number | 1447922604
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Entity Type | Organization
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Legal Business Name | OPTIMUM FAMILY HEALTH
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 9424 BAYMEADOWS RD STE 250
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7967
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Country | US
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Telephone | 904-402-5539
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Fax |
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Provider Business Mailing Address
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Address Line | 9424 BAYMEADOWS RD STE 250
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7967
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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 | OWNER
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Name | NATASHA HENDERSON
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Credential | APRN
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Telephone | 904-402-5539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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