Individual
TIKI STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
523 FERN ST, JACKSONVILLE, FL 32206-6238
(904) 764-2891
Mailing address
523 FERN ST, JACKSONVILLE, FL 32206-6238
(904) 764-2891
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
AL11189
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL11189
AHCA
FL
Enumeration date
01/11/2008
Last updated
01/11/2008
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