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General NPI Number Information
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NPI Number | 1780215913
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Entity Type | Individual
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Provider Name | BRITTNEY KEANNA GREEN HEAVEN SENT HOME
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Gender | Female
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 3037 POST ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-6031
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Country | US
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Telephone | 904-413-2073
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Fax |
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Provider Business Mailing Address
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Address Line | 9420 GIBSON AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32208-1212
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Country | US
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Telephone |
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 235720
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License Number State |
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