Individual
JENNA LUPSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
165 WELLS RD STE 203, ORANGE PARK, FL 32073-3036
(904) 269-3522
Mailing address
3468 CANYON FALLS DR, GREEN COVE SPRINGS, FL 32043-9230
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/11/2022
Last updated
07/11/2022
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