Provider Demographics
NPI:1164857850
Name:ONEAL, FELICIA K (LPN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:K
Last Name:ONEAL
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 1:6905 CRYSTAL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-5112
Mailing Address - Country:US
Mailing Address - Phone:904-993-7437
Mailing Address - Fax:
Practice Address - Street 1:6905 CRYSTAL RIVER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-5112
Practice Address - Country:US
Practice Address - Phone:904-993-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1000041066374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00245600Medicaid