Provider Information for 1871719203
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Mrs. LEEANN MARIE HALL
Sex: Female
NPI: 1871719203
Last Updated: 2023-10-18
Certification Date: 2023-10-18
Certification Date: 2023-10-18
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1871719203 | ||||||||
| Enumeration Date | 2007-04-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4016 3RD ST S # 1135 JACKSONVILLE BEACH, FL 32250-5848 United States Phone: 904-299-9657 | Fax: | ||||||||
| Primary Practice Address | 4016 3RD ST S # 1135 JACKSONVILLE BEACH, FL 32250-5848 United States Phone: 904-299-9657 | Fax: | ||||||||
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