Individual
TANEISHA EVETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6771 RHODE ISLAND DR W, JACKSONVILLE, FL 32209-1435
(904) 333-7351
Mailing address
6771 RHODE ISLAND DR W, JACKSONVILLE, FL 32209-1435
(904) 333-7351
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
480
FL
376J00000X
Homemaker
Primary
236090
FL
Other
Enumeration date
10/12/2022
Last updated
10/12/2022
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