Most Relevant Information
Provider Data
| NPI Number: | 1003346115 |
| Provider Name: | ANTONIESHA AUSTIN |
| Entity Type: | Individual |
| Taxonomy Code: | 261QD1600X |
| Specialty: | Clinic/Center |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/13/2017 |
| Last Updated: | 06/13/2017 |
Provider Practice Location
8805 NORFOLK BLVD
JACKSONVILLE
FL
322081917
Practice Location Phone/Fax
| Phone: | 9043432218 |
| Fax: |
Provider Mailing Location
PO BOX 66054
JACKSONVILLE
FL
322086054
Provider Mailing Phone/Fax
| Phone: | 9043432218 |
| Fax: |