Individual
PHYLLIS BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2925 NAVAJO AVE, FORT PIERCE, FL 34946-6740
(772) 467-9439
Mailing address
2925 NAVAJO AVE, FORT PIERCE, FL 34946-6740
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
CNA40739
FL
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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