Provider Demographics
NPI:1942857230
Name:ST.HUBERT, AGELET (AFCH PROVIDER)
Entity Type:Individual
Prefix:
First Name:AGELET
Middle Name:
Last Name:ST.HUBERT
Suffix:
Gender:M
Credentials:AFCH PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 AQUA SURF CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-0802
Mailing Address - Country:US
Mailing Address - Phone:904-554-6051
Mailing Address - Fax:866-373-1832
Practice Address - Street 1:764 AQUA SURF CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-0802
Practice Address - Country:US
Practice Address - Phone:904-554-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906603311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home