Individual
JERUSHA THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
259 BILL FRANCE BLVD. STE 200, DAYTONA BEACH, FL 32174
(386) 868-1992
Mailing address
510 S. BEACH STREET APT 1, ORMOND BEACH, FL 32174
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/18/2015
Last updated
06/18/2015
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