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General NPI Number Information
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NPI Number | 1538787866
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Entity Type | Individual
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Provider Name | TYWANNA COUNCIL
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Gender | Female
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 4720 SALISBURY ROAD #102
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City | JACKSONVILLE
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State | FL
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Zip | 32256
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Country | US
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Telephone | 904-924-4158
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Fax |
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Provider Business Mailing Address
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Address Line | 8859 OLD KINGS RD S APT 717
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City | JACKSONVILLE
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State | FL
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Zip | 32257-1748
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Country | US
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Telephone | 904-924-4158
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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 | 374J00000X
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Taxonomy Name | Doula
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA67757
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License Number State | FL
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