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Organization

DEVEREUX

Active
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Organization

DEVEREUX

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JACQUITA ELSTON (THERAPIST)
(321) 281-3840
Entity
Organization

Contact information

Practice address
5850 T G LEE BLVD, SUITE 400, ORLANDO, FL 32822-4407
(321) 281-3840
Mailing address
1010 EXECUTIVE CENTER DR, SUITE 100, ORLANDO, FL 32803-3529

Taxonomy

Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
160994624
FL

Other

Enumeration date
06/20/2012
Last updated
06/20/2012
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