Individual
ELRIDGE DAIGLE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10507 SEDGEBROOK DR, RIVERVIEW, FL 33569-8701
(813) 672-3880
Mailing address
10507 SEDGEBROOK DR, RIVERVIEW, FL 33569-8701
(813) 672-3880
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906187
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143044100
—
FL
Enumeration date
02/26/2013
Last updated
02/26/2013
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