Individual
MR. KYLE EDWIN JERSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
1128 NE 20TH PLACE, GAINESVILLE, FL 32609
(352) 234-6677
Mailing address
1128 NE 20TH PLACE, GAINESVILLE, FL 32609
(352) 234-6677
Taxonomy
Speciality
Code
Description
License number
State
163WM1400X
Nurse Massage Therapist (NMT)
RN9264326
FL
225700000X
Massage Therapist
Primary
MA60871
FL
Other
Enumeration date
05/06/2011
Last updated
05/06/2011
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