Healthcare Provider Details

I. General information

NPI: 1114486156
Provider Name (Legal Business Name): NETTIE'S LOVE & CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 8TH AVE STE A2-R2
GAINESVILLE FL
32601-5011
US

IV. Provider business mailing address

PO BOX 358774
GAINESVILLE FL
32635-8774
US

V. Phone/Fax

Practice location:
  • Phone: 352-258-3450
  • Fax:
Mailing address:
  • Phone: 352-258-3450
  • Fax: 352-373-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TANDRA LAMIKIA SIMMONS
Title or Position: CEO/ OWNER
Credential:
Phone: 352-258-3450