Active NPI
Phyllis Black
- Nurse's Aide
- Fort Pierce, FL
National Provider Identifier
1295950392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- CNA40739
- Practice address
- 2925 Navajo Ave
Fort Pierce, FL 34946-6740 - Phone
- (772) 467-9439
- NPI assigned
- Apr 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | CNA40739 | FL | Primary |
Addresses
Primary practice location
2925 Navajo Ave
Fort Pierce, FL 34946-6740
Mailing address
2925 Navajo Ave
Fort Pierce, FL 34946-6740
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNA40739 | FL | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295950392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 NAVAJO AVE",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "349466740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2925 NAVAJO AVE",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "349466740",
"telephone_number": "772-467-9439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "PHYLLIS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "FL",
"license": "CNA40739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Pierce, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.