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Contact Information

JERUSHA THACKER
259 BILL FRANCE BLVD. STE 200
DAYTONA BEACH, FL32174
 Phone: 386-868-1992
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Case Manager/Care Coordinator

171M00000X
Indicates primary specialty

NPI Profile & details for JERUSHA THACKER · (Female)

NPI Number 1194107821
Status Active
Credentials
Entity Individual
Enumeration date 06/18/2015
Last updated 06/18/2015 - About 11 years ago
Sole proprietor 1 Yes
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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