Organization
JACKSON REEF
Active
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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