Provider Demographics
NPI:1548834674
Name:NEWSOME, ANN J
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:J
Last Name:NEWSOME
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 1:3107 SPRING GLEN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5922
Mailing Address - Country:US
Mailing Address - Phone:904-405-0934
Mailing Address - Fax:800-727-9984
Practice Address - Street 1:3107 SPRING GLEN RD STE 203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5922
Practice Address - Country:US
Practice Address - Phone:904-405-0934
Practice Address - Fax:800-727-9984
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle