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Individual

TIA DENISE WOMACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2392 EDGEWOOD AVE N, JACKSONVILLE, FL 32254-1725
(904) 781-7797
Mailing address
12226 GLIMMER WAY, JACKSONVILLE, FL 32219-1864
(904) 482-9316

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
10/07/2020
Last updated
10/07/2020
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Product
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  • EDI platform