Provider Demographics
NPI:1659983203
Name:RAVNELL, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:RAVNELL
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:PO BOX 11965
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-1965
Mailing Address - Country:US
Mailing Address - Phone:904-517-6609
Mailing Address - Fax:
Practice Address - Street 1:7707 MERRILL RD STE 11965
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3714
Practice Address - Country:US
Practice Address - Phone:800-373-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker