Individual
DEMETRIUS STALLWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
490 VINEYARD LN, ORANGE PARK, FL 32073-7678
(904) 233-2008
Mailing address
490 VINEYARD LN, ORANGE PARK, FL 32073-7678
(904) 233-2008
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5192381
FL
Other
Enumeration date
05/26/2017
Last updated
07/21/2022
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