Individual
WANDA GREGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HOME HEALTH
Contact information
Practice address
5609 12TH AVE S, GULFPORT, FL 33707-3406
(727) 768-6459
Mailing address
5609 12TH AVE S, GULFPORT, FL 33707-3406
(727) 768-6459
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
CNA160714
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
933538904
HEALTHCARE
FL
Enumeration date
10/13/2023
Last updated
10/13/2023
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