Individual
MRS. AMY E LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
910 N JEFFERSON ST, JACKSONVILLE, FL 32209-6810
(904) 360-7022
(904) 798-4544
Mailing address
910 N JEFFERSON ST, JACKSONVILLE, FL 32209-6810
(904) 360-7022
(904) 798-4544
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000280400
—
FL
Enumeration date
06/03/2008
Last updated
12/21/2011
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