Provider Demographics
NPI:1003354325
Name:MCNEAL, VERA LYNELL (LPN)
Entity Type:Individual
Prefix:MS
First Name:VERA
Middle Name:LYNELL
Last Name:MCNEAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MCCONIHE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6306
Mailing Address - Country:US
Mailing Address - Phone:757-389-1472
Mailing Address - Fax:
Practice Address - Street 1:1220 MCCONIHE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6306
Practice Address - Country:US
Practice Address - Phone:757-389-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5197050164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014571500OtherMEDWAIVER