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General NPI Number Information
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NPI Number | 1477208288
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Entity Type | Individual
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Provider Name | TONJAMEKA R SOUTHERN RN
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Gender | Female
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 811 N MARKET ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202
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Country | US
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Telephone | 317-514-0857
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Fax |
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Provider Business Mailing Address
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Address Line | 4674 EMPIRE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2191
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Country | US
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Telephone | 317-514-0857
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9521589
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | RN9521589
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2083C0008X
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Taxonomy Name | Clinical Informatics Physician
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License Number | RN9521589
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | RN9521589
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License Number State | FL
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