MEDICARE: MS. AMEDIA RENAY JONES CNA/OWNER

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	374U00000X	Home Health Aide	2200027088	FL

General Provider Information

NPI Number	:	1952016164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMEDIA RENAY JONES CNA/OWNER

Provider Business Mailing Address
First Line	:	405 SAN PEDRO AVE SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-3436
Country	:	US
Telephone Number	:	804-564-2374
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 SAN PEDRO AVE SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-3436
Country	:	US
Telephone Number	:	804-564-2374
Fax Number	:

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

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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