Provider Demographics
NPI:1417370727
Name:SEABROOKS, JOLANDER LOLITAR
Entity Type:Individual
Prefix:MR
First Name:JOLANDER
Middle Name:LOLITAR
Last Name:SEABROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 WOODBINE WAY APT 516
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6548
Mailing Address - Country:US
Mailing Address - Phone:910-476-6574
Mailing Address - Fax:
Practice Address - Street 1:590 WOODBINE WAY APT 516
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-6548
Practice Address - Country:US
Practice Address - Phone:910-476-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL464132095251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management