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General NPI Number Information
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NPI Number | 1962225995
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Entity Type | Organization
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Legal Business Name | DIVINE PURPOSE LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 3872 TRAIL RIDGE RD
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City | MIDDLEBURG
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State | FL
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Zip | 32068
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Country | US
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Telephone | 904-689-6854
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Fax |
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Provider Business Mailing Address
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Address Line | 1075 OAKLEAF PLANTATION PKWY SUITE 304, #181
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City | ORANGE PARK
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State | FL
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Zip | 32065
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Country | US
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Telephone | 904-689-6854
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBRA SMOTHERS
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Credential |
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Telephone | 904-689-6854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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