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Individual

NEFERTITI TATE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DIRECTOR

Contact information

Practice address
945 25TH DR E STE 1, ELLENTON, FL 34222-2054
(941) 981-5342
(941) 981-5351
Mailing address
945 25TH DR E STE 1, ELLENTON, FL 34222-2054
(941) 981-5342
(941) 981-5351

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
347C00000X
Private Vehicle
372600000X
Adult Companion
Primary
233808
FL
376J00000X
Homemaker
233808
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
233808
STATE LICENSE
FL
01
233951
STATE LICENSE
FL
Enumeration date
02/09/2015
Last updated
06/10/2019
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