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NPI Code Detail

MEDICARE: JENNIFER L. CANNESTRA L.AC.

MEDICARE: JENNIFER L. CANNESTRA L.AC.
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
1171100000XAcupuncturistAP2394FL

General Provider Information

NPI Number : 1508161498
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER L. CANNESTRA L.AC.
Provider Business Mailing Address
First Line : 4495-304 ROOSEVELT BLVD. #296
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-5815
Country : US
Telephone Number : 904-868-4959
Fax Number :
Provider Business Practice Location Address
First Line : 4155 OXFORD AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-4425
Country : US
Telephone Number : 904-868-4959
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2011
Last Update Date : 01/24/2011

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