Provider Demographics
NPI:1730922451
Name:RESTORING HEALTH MOBILE MEDICAL LLC
Entity type:Organization
Organization Name:RESTORING HEALTH MOBILE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUGULEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:912-674-4517
Mailing Address - Street 1:9428 BAYMEADOWS RD STE 502
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7973
Mailing Address - Country:US
Mailing Address - Phone:904-902-0736
Mailing Address - Fax:904-902-0768
Practice Address - Street 1:9428 BAYMEADOWS RD STE 502
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7973
Practice Address - Country:US
Practice Address - Phone:904-902-0736
Practice Address - Fax:904-902-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care