Healthcare Provider Details

I. General information

NPI: 1427643402
Provider Name (Legal Business Name): CONCEPTIA CHARMINE GEFFRARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 LAKE JACKSON CIR
APOPKA FL
32703-5842
US

IV. Provider business mailing address

887 LAKE JACKSON CIR
APOPKA FL
32703-5842
US

V. Phone/Fax

Practice location:
  • Phone: 407-272-8267
  • Fax:
Mailing address:
  • Phone: 407-272-8267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9491074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: