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NPI Code Detail

MEDICARE: AUTUMN BETH VAUGHN A.P., DIP. O.M.

MEDICARE: AUTUMN BETH VAUGHN A.P., DIP. O.M.
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
1171100000XAcupuncturist3654FL

General Provider Information

NPI Number : 1538647912
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN BETH VAUGHN A.P., DIP. O.M.
Provider Business Mailing Address
First Line : 5418 STETSON RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-7860
Country : US
Telephone Number : 352-665-8884
Fax Number :
Provider Business Practice Location Address
First Line : 8777 SAN JOSE BLVD STE 701
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-4292
Country : US
Telephone Number : 352-665-8884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2018
Last Update Date : 07/30/2018

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Directions to “ AUTUMN BETH VAUGHN A.P., DIP. O.M.” Practice Location

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