Individual
LEA R BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14600 WHIRLWIND AVE, JACKSONVILLE, FL 32218-9437
(904) 447-7577
Mailing address
4408 SUN LILY CT, JACKSONVILLE, FL 32257-8099
(904) 710-3854
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
225400000X
Rehabilitation Practitioner
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
08/11/2025
Last updated
08/11/2025
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