Individual
KOSHANNA THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5818 BLACKTHORN RD, JACKSONVILLE, FL 32244-2010
(904) 674-4260
Mailing address
5818 BLACKTHORN RD, JACKSONVILLE, FL 32244-2010
(904) 674-4260
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
Primary
—
FL
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-4457708
—
FL
Enumeration date
03/13/2018
Last updated
03/13/2018
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