Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA90937 | FL |
NPI | 1003585639 |
---|---|
Provider Name | Jamie Desiree Paugam |
First Address | Jacksonville, FL 32207-1038 |
Second Address | Jacksonville, FL 32207-1038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2021 |
Last Update Date | 08/09/2021 |