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Individual provider Active NPI Home Health Aide · Archer, FL
NPI 1649685256 · NPPES record last updated Sep 9, 2014
Key facts
- NPI
- 1649685256
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Aide 374U00000X
- Practice address
- 17073 S.W. 127TH Place
Archer, FL 32618 - Phone
- (352) 225-2035
- Fax
- (352) 335-6438
- NPI assigned
- Jun 23, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Yes |
Addresses
Primary practice location
17073 S.W. 127TH Place
Archer, FL 32618
Mailing address
PO Box 1244
Archer, FL 32618-1244
Phone (352) 225-2035
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004411500 | Medicaid | FL |
Other providers in Archer, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.