Provider Demographics
NPI:1245599281
Name:JACKSONVILLE ACUPUNCTURE WELLNESS, PA
Entity Type:Organization
Organization Name:JACKSONVILLE ACUPUNCTURE WELLNESS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEL
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:904-859-5333
Mailing Address - Street 1:27 ARBOR CLUB DR
Mailing Address - Street 2:SUITE #216
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2666
Mailing Address - Country:US
Mailing Address - Phone:904-859-5333
Mailing Address - Fax:
Practice Address - Street 1:3016 3RD ST S
Practice Address - Street 2:SUITE 102
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6011
Practice Address - Country:US
Practice Address - Phone:904-859-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty