MEDICARE: B JAZZY SALON INC

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1952955627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B JAZZY SALON INC

Provider Business Mailing Address
First Line	:	5116 GATE PKWY APT 5111
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0265
Country	:	US
Telephone Number	:	904-716-9432
Fax Number	:

Provider Business Practice Location Address
First Line	:	5116 GATE PKWY APT 5111
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0265
Country	:	US
Telephone Number	:	904-716-9432
Fax Number	:

Authorized Official
Title or Position	:	OWNER/STYLIST PRESIDENT
Name	:	MS. CARLISE YVETTE CHARLOT
Credential	:	LIC COSMETOLOGIST
Telephone Number	:	904-716-9432

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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Directions to “B JAZZY SALON INC ” Practice Location

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