Provider Demographics
NPI:1063241917
Name:KENNEDY, SEQUOIA
Entity type:Individual
Prefix:
First Name:SEQUOIA
Middle Name:
Last Name:KENNEDY
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 1:4110 SOUTHPOINT BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0925
Mailing Address - Country:US
Mailing Address - Phone:904-257-4244
Mailing Address - Fax:
Practice Address - Street 1:4110 SOUTHPOINT BLVD STE 107
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0925
Practice Address - Country:US
Practice Address - Phone:904-257-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide