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General NPI Number Information
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NPI Number | 1760381917
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Entity Type | Organization
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Legal Business Name | FANTASTIC GARDENS ASSISTED LIVING LLC DBA FANTASTIC GARDENS HOME HEALTHCARE
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 153 BLANDING BLVD STE 4
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City | ORANGE PARK
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State | FL
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Zip | 32073-2613
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Country | US
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Telephone | 904-372-3736
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Fax |
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Provider Business Mailing Address
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Address Line | 153 BLANDING BLVD STE 4
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City | ORANGE PARK
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State | FL
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Zip | 32073-2613
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Country | US
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Telephone | 904-372-3736
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Fax |
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Authorized Official
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Title or Position | LPN/ADMINISTRATOR
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Name | MRS. SHERRY S JOHNSON
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Credential |
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Telephone | 904-554-0369
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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 |
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License Number State |
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