Organization
DEVEREUX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUITA ELSTON (THERAPIST)
(321) 281-3840
Entity
Organization
Contact information
Practice address
5850 T G LEE BLVD, SUITE 400, ORLANDO, FL 32822-4407
(321) 281-3840
Mailing address
1010 EXECUTIVE CENTER DR, SUITE 100, ORLANDO, FL 32803-3529
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
160994624
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029573621
—
FL
Enumeration date
06/20/2012
Last updated
06/20/2012
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