Provider Demographics
NPI:1023667722
Name:NEEL, JUSTIN P
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:P
Last Name:NEEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5538 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8208
Mailing Address - Country:US
Mailing Address - Phone:850-983-2148
Mailing Address - Fax:
Practice Address - Street 1:5538 WESLEY DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8208
Practice Address - Country:US
Practice Address - Phone:850-983-2148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider