Individual
TYEISHA HAYWARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
1341 ELLIS TRACE DR W, JACKSONVILLE, FL 32205-6128
(904) 290-9752
Mailing address
1341 ELLIS TRACE DR W, JACKSONVILLE, FL 32205-6128
(904) 290-9752
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
376K00000X
Nurse's Aide
Primary
229348
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
229348
DEPARTMENT OF HEALTH
FL
Enumeration date
06/01/2019
Last updated
11/30/2021
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