MEDICARE: MS. APRIL EBONY HODGE

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	374T00000X	Religious Nonmedical Nursing Personnel
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1821798737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. APRIL EBONY HODGE

Provider Business Mailing Address
First Line	:	11111 SAN JOSE BLVD STE 56
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7274
Country	:	US
Telephone Number	:	904-465-7928
Fax Number	:

Provider Business Practice Location Address
First Line	:	8010 FOXDALE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-4637
Country	:	US
Telephone Number	:	904-718-3536
Fax Number	:

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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