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Individual

TIA FAYE PARKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1728 KINGSLEY AVE STE 1, ORANGE PARK, FL 32073-4456
(904) 397-3405
Mailing address
9951 ATLANTIC BLVD STE 262, JACKSONVILLE, FL 32225-6589
(904) 397-3405

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
253Z00000X
In Home Supportive Care Agency
376J00000X
Homemaker
Primary
234744
FL

Other

Enumeration date
07/12/2017
Last updated
03/29/2023
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