1245599281 NPI number — JACKSONVILLE ACUPUNCTURE WELLNESS, PA

Table of content: (NPI 1245599281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245599281 NPI number — JACKSONVILLE ACUPUNCTURE WELLNESS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSONVILLE ACUPUNCTURE WELLNESS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245599281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 ARBOR CLUB DR
Provider Second Line Business Mailing Address:
SUITE #216
Provider Business Mailing Address City Name:
PONTE VEDRA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32082-2666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-859-5333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3016 3RD ST S
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
JACKSONVILLE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32250-6011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-859-5333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RUEL
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-859-5333

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AP2548 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com