Provider Demographics
NPI:1679106165
Name:GREENE, ELEXIS ARNOLD
Entity type:Individual
Prefix:
First Name:ELEXIS
Middle Name:ARNOLD
Last Name:GREENE
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 1:1484 DAKAR ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7359
Mailing Address - Country:US
Mailing Address - Phone:909-616-8666
Mailing Address - Fax:
Practice Address - Street 1:1484 DAKAR ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-7359
Practice Address - Country:US
Practice Address - Phone:909-616-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health