Individual
MRS. TEQUELA YASHAN DONALDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14044 FRIENDSHIP PL, SANDERSON, FL 32087-2489
(904) 408-6638
(904) 409-0012
Mailing address
PO BOX 163, SANDERSON, FL 32087-0163
(904) 408-6638
(904) 409-0012
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
735303
—
FL
Enumeration date
11/29/2018
Last updated
11/29/2018
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