Provider Information for 1164059648
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JEANNA FELICITA HOUSTON
Sex: Female
NPI: 1164059648
Last Updated: 2020-03-25
Certification Date: 2020-03-25
Certification Date: 2020-03-25
Details
Name | Value | ||||||||||||||
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NPI | 1164059648 | ||||||||||||||
Enumeration Date | 2020-03-25 | ||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||
Sole Proprietor | YES | ||||||||||||||
Status | Active | ||||||||||||||
Mailing Address | 3810-3 WILLIAMSBURG PARK BLVD JACKSONVILLE, FL 32257-9220 United States Phone: 904-419-6102 | Fax:904-739-2153 | ||||||||||||||
Primary Practice Address | 3810-3 WILLIAMSBURG PARK BLVD JACKSONVILLE, FL 32257-9220 United States Phone: 904-419-6102 | Fax:904-739-2153 | ||||||||||||||
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