Individual
JACARA WARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1905 COX ST, FORT MYERS, FL 33916-4130
(602) 214-0432
Mailing address
2134 BARDEN ST., FORT MYERS, FL 33916
(480) 221-8880
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111103900
—
FL
Enumeration date
02/14/2022
Last updated
02/14/2022
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