Individual
JAVARA TROUPE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10043 VICTORY GALLOP LOOP, RUSKIN, FL 33573-6744
(813) 481-4419
Mailing address
10043 VICTORY GALLOP LOOP, RUSKIN, FL 33573-6744
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
16404
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TRV956224084
BLUECROSS BLUESHIELD
NV
Enumeration date
04/21/2020
Last updated
04/21/2020
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