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General NPI Number Information
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NPI Number | 1760909337
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Entity Type | Individual
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Provider Name | MS. TEKIA J PORTER
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Gender | Female
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 08/24/2017
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Provider Practice Location Address
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Address Line | 732 TORREY PINE CIR N
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City | JACKSONVILLE
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State | FL
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Zip | 32218-3776
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Country | US
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Telephone | 904-600-2530
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2273
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City | JACKSONVILLE
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State | FL
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Zip | 32203-2273
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Country | US
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Telephone | 904-600-2530
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 235002
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License Number State | FL
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