Individual
GERTRUDE DORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21936 BEVERLY AVE, PORT CHARLOTTE, FL 33952-5429
(941) 467-2665
Mailing address
21936 BEVERLY AVE, PORT CHARLOTTE, FL 33952-5429
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-3948492
TAX IDENTIFICATION
FL
Enumeration date
01/08/2022
Last updated
01/08/2022
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