Provider Information for 1386773638
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Mrs. TABITHA YVETTE DUCKWORTH LISW-Supv
Sex: Female
NPI: 1386773638
Last Updated: 2008-11-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1386773638 | ||||||||||||
| Enumeration Date | 2007-03-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3661 THOUSAND OAKS DR ORANGE PARK, FL 32065-4245 United States Phone: 904-566-1883 | Fax: | ||||||||||||
| Primary Practice Address | 619 S MARION AVE LAKE CITY VA MEDICAL CENTER LAKE CITY, FL 32025-5808 United States Phone: 386-755-3016 | Fax: | ||||||||||||
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