Individual
MISTY D PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
910 N JEFFERSON ST, JACKSONVILLE, FL 32209-6810
(904) 360-7022
Mailing address
431 SHAMROCK RD, ST AUGUSTINE, FL 32086-6561
(904) 360-7022
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/29/2010
Last updated
01/29/2010
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