Individual
JANE DOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10225 ULMERTON RD STE 10C, LARGO, FL 33771-3526
(727) 261-6222
(727) 848-5494
Mailing address
7335 MITCHELL RANCH RD, NEW PORT RICHEY, FL 34655-3233
(727) 271-8884
(727) 848-5494
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
001819400
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001819400
—
FL
Enumeration date
02/13/2018
Last updated
02/13/2018
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