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General NPI Number Information
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NPI Number | 1790406148
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Entity Type | Organization
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Legal Business Name | AT HOME PALLIATIVE CARE, LLC
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 263 RIVER HILLS DR STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8980
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Country | US
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Telephone | 904-222-2273
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Fax | 904-902-8227
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Provider Business Mailing Address
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Address Line | 463688 STATE ROAD 200, STE 1 #364
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City | YULEE
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State | FL
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Zip | 32097
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Country | US
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Telephone | 478-290-0677
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CRYSTAL CISZEK
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Credential | FNP-C
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Telephone | 478-290-0677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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