Individual
IDA MARIE PALMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6722 ARLINGTON EXPY # 570, JACKSONVILLE, FL 32211-7234
(904) 601-8426
Mailing address
6722 ARLINGTON EXPY # 570, JACKSONVILLE, FL 32211-7234
(904) 601-8426
Taxonomy
Speciality
Code
Description
License number
State
103TH0004X
Health Psychologist
Primary
103TH0100X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G18000033026
—
FL
Enumeration date
05/21/2019
Last updated
05/21/2019
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