MEDICARE: PASSIONATE HANDS HOME CARE AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	961	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1033075700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSIONATE HANDS HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	1317 W 7TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6206
Country	:	US
Telephone Number	:	904-610-1530
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 W 7TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6206
Country	:	US
Telephone Number	:	904-610-1530
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIA EDWARDS
Credential	:
Telephone Number	:	904-610-1530

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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Directions to “PASSIONATE HANDS HOME CARE AGENCY LLC ” Practice Location

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