Individual
DANA L AVANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2212 HOLLYWOOD AVE, EUSTIS, FL 32726-3218
(352) 348-2016
Mailing address
2212 HOLLYWOOD AVE, EUSTIS, FL 32726-3218
(352) 348-2016
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
571233178
FL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
571233178
FL
343900000X
Non-emergency Medical Transport (VAN)
Primary
571233178
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
571233178
FL
Other
Enumeration date
12/30/2013
Last updated
12/30/2013
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