MEDICARE: JODECI WEAVER

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1053169615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODECI WEAVER

Provider Business Mailing Address
First Line	:	3601 KERNAN BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-9602
Country	:	US
Telephone Number	:	904-610-0041
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 KERNAN BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-9602
Country	:	US
Telephone Number	:	904-610-0041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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Directions to “ JODECI WEAVER ” Practice Location

Language	Start Address	Practice Location

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