Individual
ETHELDRA A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10611 NW SR 20, BRISTOL, FL 32321-3232
(850) 643-1033
Mailing address
8116 BLENHEIM LN, TALLAHASSEE, FL 32312-6802
(850) 345-2416
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
ISW13573
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ISW13573
STATE OF FLORIDA DOH
FL
Enumeration date
10/15/2019
Last updated
10/15/2019
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