Organization
JACKSON REEF
Active
Other names
Life Is Ketaful
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM LOUIS SELF DNP, CRNA (OWNER)
(386) 487-4673
Entity
Organization
Contact information
Practice address
495 S NOVA RD STE 101A, ORMOND BEACH, FL 32174-8444
(386) 487-4673
(855) 829-5770
Mailing address
495 S NOVA RD STE 101A, ORMOND BEACH, FL 32174-8444
(386) 487-4673
(855) 829-5770
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
07/17/2019
Last updated
08/07/2020
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