Individual
MR. DECORKUS ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
211 GAY ST, HAVANA, FL 32333-1646
(850) 274-7104
Mailing address
211 GAY ST, HAVANA, FL 32333-1646
(850) 274-7104
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
235485
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021500500
—
FL
Enumeration date
05/01/2018
Last updated
08/04/2022
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