Individual
PORSHA OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
400 SAND PINE DR, MIDWAY, FL 32343-4228
(850) 241-4262
Mailing address
400 SAND PINE DR, MIDWAY, FL 32343-4228
(850) 241-4262
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5181982
FL
Other
Enumeration date
02/22/2017
Last updated
02/22/2017
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