Healthcare Provider Details

I. General information

NPI: 1881829190
Provider Name (Legal Business Name): KITTY LOUISE TRAVEL NURSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2009
Last Update Date: 05/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 HIDDEN PINES CIR
CASSELBERRY FL
32707-3361
US

IV. Provider business mailing address

341 HIDDEN PINES CIR
CASSELBERRY FL
32707-3361
US

V. Phone/Fax

Practice location:
  • Phone: 407-272-1526
  • Fax:
Mailing address:
  • Phone: 407-272-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberCNA0304027
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberCNA0304027
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberCNA0304027
License Number StateIN

VIII. Authorized Official

Name: ERICA LOUISE TATE
Title or Position: CNA
Credential:
Phone: 407-272-1526