Individual
VIOLANGE JOSEPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3310 SW FRANKFORD ST, PORT ST LUCIE, FL 34953-4937
(786) 326-8742
Mailing address
3310 SW FRANKFORD ST, PORT ST LUCIE, FL 34953-4937
(786) 326-8742
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J210-860-84-872-0
DRIVER LICENSE
FL
01
—
J210860848720
DRIVER LICENSE
FL
Enumeration date
10/29/2020
Last updated
10/29/2020
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