Individual
ALICE TIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2363 SE BREKENRIDGE CIR, PORT ST LUCIE, FL 34952-8139
(954) 200-1595
Mailing address
2363 SE BREKENRIDGE CIR, PORT ST LUCIE, FL 34952-8139
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
800137625
—
FL
Enumeration date
03/27/2019
Last updated
03/27/2019
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