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General NPI Number Information
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NPI Number | 1457030876
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Entity Type | Individual
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Provider Name | DEANNA DARNELL SPENCER
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Gender | Female
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 118 OHIO AVE N STE A
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City | LIVE OAK
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State | FL
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Zip | 32064-2464
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Country | US
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Telephone | 386-243-5805
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | JASPER
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State | FL
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Zip | 32052-0070
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Country | US
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Telephone | 386-397-0884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA103124
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License Number State | FL
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