Individual
AVIS SHANTRELL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 NW 66TH ST, MIAMI, FL 33147-7444
(786) 333-4557
Mailing address
1700 NW 66TH ST, MIAMI, FL 33147-7444
(786) 333-4557
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
FL
Other
Enumeration date
12/20/2019
Last updated
12/20/2019
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