Individual
JESSIE MARIE DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
79 HENTHORNE DR, LAKE WORTH, FL 33461-2917
(561) 689-1799
Mailing address
79 HENTHORNE DR, LAKE WORTH, FL 33461-2917
(561) 689-1799
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
PTA16575
FL
Other
Enumeration date
03/13/2012
Last updated
03/13/2012
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