Provider Demographics
NPI:1811703564
Name:PUENARY, NESERT ELLAINE (ASSOCIATE IN SCIENCE)
Entity type:Individual
Prefix:
First Name:NESERT ELLAINE
Middle Name:
Last Name:PUENARY
Suffix:
Gender:F
Credentials:ASSOCIATE IN SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 ARORA BLVD APT 1102
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3282
Mailing Address - Country:US
Mailing Address - Phone:904-510-6241
Mailing Address - Fax:
Practice Address - Street 1:9560 CROSSHILL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-5827
Practice Address - Country:US
Practice Address - Phone:904-203-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32602225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant