Provider Demographics
NPI:1497914857
Name:HUNTER, RENAY ANNETTE (OWNER)
Entity Type:Individual
Prefix:MISS
First Name:RENAY
Middle Name:ANNETTE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 DALLEN LEA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1603
Mailing Address - Country:US
Mailing Address - Phone:904-924-8023
Mailing Address - Fax:904-766-3392
Practice Address - Street 1:4903 DALLEN LEA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1603
Practice Address - Country:US
Practice Address - Phone:904-924-8023
Practice Address - Fax:904-766-3392
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230297376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693676895Medicaid