Provider Demographics
NPI:1568978880
Name:JONES, TILANDRA
Entity Type:Individual
Prefix:
First Name:TILANDRA
Middle Name:
Last Name:JONES
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 1:3650 GILMORE HEIGHTS RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4398
Mailing Address - Country:US
Mailing Address - Phone:904-660-4551
Mailing Address - Fax:
Practice Address - Street 1:3650 GILMORE HEIGHTS RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4398
Practice Address - Country:US
Practice Address - Phone:904-660-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL822624370Medicaid