Provider Demographics
NPI:1114223955
Name:A WAY OF LIFE ACUPUNCTURE, PLLC
Entity Type:Organization
Organization Name:A WAY OF LIFE ACUPUNCTURE, PLLC
Other - Org Name:A WAY OF LIFE ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YASTRZEMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:904-373-8415
Mailing Address - Street 1:4337 PABLO OAKS COURT
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224
Mailing Address - Country:US
Mailing Address - Phone:904-373-8415
Mailing Address - Fax:
Practice Address - Street 1:4337 PABLO OAKS COURT
Practice Address - Street 2:BUILDING 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224
Practice Address - Country:US
Practice Address - Phone:904-373-8415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL2255171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty