Provider Demographics
NPI:1619147378
Name:AVERY, SOPHIE D (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIE
Middle Name:D
Last Name:AVERY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 N LAKE CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7938
Mailing Address - Country:US
Mailing Address - Phone:904-287-3350
Mailing Address - Fax:
Practice Address - Street 1:188 N LAKE CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-7938
Practice Address - Country:US
Practice Address - Phone:904-287-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 1262721164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse