MEDICARE: MS. ASHLEY ODOL CNA MA

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	376K00000X	Nurse's Aide	317712	FL

General Provider Information

NPI Number	:	1184160418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY ODOL CNA MA

Provider Business Mailing Address
First Line	:	641 REFLECTION COVE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8936
Country	:	US
Telephone Number	:	904-601-8578
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 REFLECTION COVE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8936
Country	:	US
Telephone Number	:	904-601-8578
Fax Number	:

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

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/10/2017

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