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General NPI Number Information
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NPI Number | 1598133563
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Entity Type | Organization
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Legal Business Name | COMMUNITY INCOME TAX OF JACKSONVILLE
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 2506 JAMMES RD UNIT 14
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City | JACKSONVILLE
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State | FL
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Zip | 32210-3786
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Country | US
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Telephone | 904-438-5128
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Fax | 904-438-5128
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Provider Business Mailing Address
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Address Line | 2506 JAMMES RD UNIT 14
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City | JACKSONVILLE
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State | FL
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Zip | 32210-3786
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Country | US
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Telephone | 904-438-5128
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Fax | 904-438-5128
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Authorized Official
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Title or Position | OWNER
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Name | CHERYL LYNETTE SMITH
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Credential |
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Telephone | 904-304-5339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | P234782
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License Number State | FL
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