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Individual

TYSHEANA PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6717 SOUTHERN OAKS DR, JACKSONVILLE, FL 32244-3675
(904) 575-5082
Mailing address
PO BOX 440222, JACKSONVILLE, FL 32222-0021
(904) 575-5082

Taxonomy

Speciality
Code
Description
License number
State
372500000X
Chore Provider
FL
374U00000X
Home Health Aide
FL
376J00000X
Homemaker
Primary
236899
FL

Other

Enumeration date
07/30/2020
Last updated
09/17/2021
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