Individual
MRS. VERA RENITA MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
331 THOMASDALE AVE, HAINES CITY, FL 33844-6381
(863) 242-1261
Mailing address
331 THOMASDALE AVE, HAINES CITY, FL 33844-6381
(863) 242-1261
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906328
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002740700
—
FL
Enumeration date
09/06/2013
Last updated
09/06/2013
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