Individual
MR. DAVID E DAXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1768 30TH ST S, ST PETERSBURG, FL 33712-2536
(727) 307-9190
Mailing address
1768 30TH ST S, ST PETERSBURG, FL 33712-2536
(727) 307-9190
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/06/2022
Last updated
02/06/2022
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