Individual
FAYE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2125 HYDE PARK RD APT 2, JACKSONVILLE, FL 32210-3857
(904) 610-7479
Mailing address
2125 HYDE PARK RD APT 21, JACKSONVILLE, FL 32210-3876
(904) 400-2232
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-2005980
—
FL
Enumeration date
06/28/2017
Last updated
07/21/2022
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