Provider Demographics
NPI:1447902788
Name:GIDDENS, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GIDDENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 KERNAN FOREST BLVD APT 2605
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7538
Mailing Address - Country:US
Mailing Address - Phone:757-709-3048
Mailing Address - Fax:
Practice Address - Street 1:12301 KERNAN FOREST BLVD APT 2605
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7538
Practice Address - Country:US
Practice Address - Phone:757-709-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist