Provider Demographics
NPI:1386399244
Name:HALL, IEESHA (IEESHA HALL RN)
Entity type:Individual
Prefix:MRS
First Name:IEESHA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:IEESHA HALL RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 HARTS RD APT 902
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-3741
Mailing Address - Country:US
Mailing Address - Phone:904-520-1073
Mailing Address - Fax:
Practice Address - Street 1:11501 HARTS RD APT 902
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3741
Practice Address - Country:US
Practice Address - Phone:904-520-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9551819251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services