Individual
MRS. AGNES MAE FREEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
160 HIBISCUS LN, DELTONA, FL 32738-9335
(407) 792-9678
Mailing address
160 HIBISCUS LN, DELTONA, FL 32738-9335
(407) 792-9678
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
17200000X
FL
172V00000X
Community Health Worker
Primary
687652896
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687652896
—
FL
05
—
687652897
—
FL
Enumeration date
12/17/2010
Last updated
12/17/2010
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