Organization
DURRANCE MEDICAID PROVIDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY DURRANCE (OWNER)
(904) 226-5719
Entity
Organization
Contact information
Practice address
9257 SW 137TH ST, STARKE, FL 32091-5974
(904) 226-5719
Mailing address
9257 SW 137TH ST, STARKE, FL 32091-5974
(904) 226-5719
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0043554
—
FL
Enumeration date
11/23/2021
Last updated
11/23/2021
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