MEDICARE: MS. LASHONDA OGLESBY C.N.A.

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
2	310400000X	Assisted Living Facility
3	372500000X	Chore Provider
4	372600000X	Adult Companion
5	376J00000X	Homemaker
6	385H00000X	Respite Care
7	374U00000X	Home Health Aide	CNA254608	FL

General Provider Information

NPI Number	:	1073090437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LASHONDA OGLESBY C.N.A.

Provider Business Mailing Address
First Line	:	6313 ARLINGTON RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5423
Country	:	US
Telephone Number	:	904-444-7436
Fax Number	:	302-347-9830

Provider Business Practice Location Address
First Line	:	6313 ARLINGTON RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5423
Country	:	US
Telephone Number	:	904-444-7436
Fax Number	:	302-347-9830

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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