Individual
SIA KAMANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
9974 TIMBER FALLS LN, JACKSONVILLE, FL 32219-4357
(904) 612-8558
Mailing address
9974 TIMBER FALLS LN, JACKSONVILLE, FL 32219-4357
(904) 612-8558
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5174791
FL
251E00000X
Home Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN5174791
LPN
FL
Enumeration date
09/13/2018
Last updated
09/19/2018
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