Provider Demographics
NPI:1568025849
Name:WAYMON, FREDRICKA D
Entity Type:Individual
Prefix:
First Name:FREDRICKA
Middle Name:D
Last Name:WAYMON
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 1:8016 RENAULT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1326
Mailing Address - Country:US
Mailing Address - Phone:910-478-4799
Mailing Address - Fax:
Practice Address - Street 1:8016 RENAULT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1326
Practice Address - Country:US
Practice Address - Phone:910-478-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care