MEDICARE: MRS. IEESHA HALL IEESHA HALL RN

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	251C00000X	Developmentally Disabled Services Day Training Agency	9551819	FL

General Provider Information

NPI Number	:	1386399244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IEESHA HALL IEESHA HALL RN

Provider Business Mailing Address
First Line	:	11501 HARTS RD APT 902
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-3741
Country	:	US
Telephone Number	:	904-520-1073
Fax Number	:

Provider Business Practice Location Address
First Line	:	11501 HARTS RD APT 902
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-3741
Country	:	US
Telephone Number	:	904-520-1073
Fax Number	:

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

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	02/18/2022

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