MEDICARE: RESTORING HEALTH MOBILE MEDICAL LLC

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1730922451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORING HEALTH MOBILE MEDICAL LLC

Provider Business Mailing Address
First Line	:	9428 BAYMEADOWS RD STE 502
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7973
Country	:	US
Telephone Number	:	904-902-0736
Fax Number	:	904-902-0768

Provider Business Practice Location Address
First Line	:	9428 BAYMEADOWS RD STE 502
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7973
Country	:	US
Telephone Number	:	904-902-0736
Fax Number	:	904-902-0768

Authorized Official
Title or Position	:	OWNER
Name	:	LATOYA R HUGULEY
Credential	:	APRN
Telephone Number	:	912-674-4517

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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