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General NPI Number Information
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NPI Number | 1659540763
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Entity Type | Organization
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Legal Business Name | TIDAJAY CARE SERVICES INC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 1140 SUNRAY CT
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8038
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Country | US
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Telephone | 904-714-1020
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Fax | 904-714-4501
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Provider Business Mailing Address
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Address Line | 1140 SUNRAY CT
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8038
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Country | US
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Telephone | 904-714-1020
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Fax | 904-714-4501
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MUSU KAISAMBA JUSU
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Credential |
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Telephone | 904-714-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5159858
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License Number State | FL
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