Individual
DECINTHIES SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1526 W 19TH ST, JACKSONVILLE, FL 32209-4914
(904) 290-9476
Mailing address
1526 W 19TH ST, JACKSONVILLE, FL 32209-4914
(904) 290-9476
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
09/17/2024
Last updated
09/17/2024
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