Provider Demographics
NPI:1760913339
Name:JONES, ETHEL BERNADINE
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:BERNADINE
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 1:1110 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6079
Mailing Address - Country:US
Mailing Address - Phone:352-504-1327
Mailing Address - Fax:
Practice Address - Street 1:1110 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6079
Practice Address - Country:US
Practice Address - Phone:352-504-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health