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Individual

ANDRE DORVAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
11380 SW HILLCREST CIR, PORT ST LUCIE, FL 34987-2704
(772) 940-9219
Mailing address
1258 SW ERMINE AVE, PORT ST LUCIE, FL 34953-5006
(772) 207-7947
(772) 333-2814

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9279980
FL
3747P1801X
Personal Care Attendant
376K00000X
Nurse's Aide

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
012975500
FL
Enumeration date
01/28/2016
Last updated
01/28/2016
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