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Individual

MRS. DETRESE DENESE MIXON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNA,CMA

Contact information

Practice address
1936 MEHARRY AVE, JACKSONVILLE, FL 32209-2622
(904) 766-5815
Mailing address
1936 MEHARRY AVE, JACKSONVILLE, FL 32209-2622
(904) 766-5815

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
CNA 112950
FL

Other

Enumeration date
02/29/2008
Last updated
02/29/2008
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