Individual
SHAKITA MARIA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1455 CARPATHIAN DR, JACKSONVILLE, FL 32218-7974
(904) 524-7263
Mailing address
1455 CARPATHIAN DR, JACKSONVILLE, FL 32218-7974
(904) 524-7263
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5213896
FL
Other
Enumeration date
02/26/2016
Last updated
02/26/2016
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