Individual
THERESA G COUNCIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2815 MELSON AVE, JACKSONVILLE, FL 32254-1853
(904) 570-9418
(904) 570-9418
Mailing address
2815 MELSON AVE, JACKSONVILLE, FL 32254-1853
(904) 570-9418
(904) 570-9418
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
FL
172V00000X
Community Health Worker
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-2700348
—
FL
Enumeration date
06/06/2018
Last updated
06/11/2019
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