Individual
TECO GERVASINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12029 29TH RD, WELLBORN, FL 32094-2037
(386) 288-1503
Mailing address
12029 29TH RD, WELLBORN, FL 32094-2037
(386) 288-1503
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
614627
—
FL
Enumeration date
02/10/2016
Last updated
02/10/2016
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