Individual
MR. RUSSELL WAYNE TOLLIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4083 SUNBEAM RD, APARTMENT 1409, JACKSONVILLE, FL 32257-8993
(904) 733-1338
Mailing address
4083 SUNBEAM RD, APARTMENT 1409, JACKSONVILLE, FL 32257-8993
(904) 733-1338
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
08/21/2007
Last updated
08/21/2007
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