Organization
TIA DWANA COLLECTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHEA WHITEHURST (OWNER)
(904) 532-3475
Entity
Organization
Contact information
Practice address
7643 GATE PKWY STE 104-333, JACKSONVILLE, FL 32256-2893
(904) 532-3475
(904) 977-8900
Mailing address
7643 GATE PKWY STE 104-333, JACKSONVILLE, FL 32256-2893
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
12/23/2020
Last updated
01/18/2021
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