Healthcare Provider Details

I. General information

NPI: 1013625367
Provider Name (Legal Business Name): DERRICKA HERBERT CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 SW ARCHER RD
GAINESVILLE FL
32608-1316
US

IV. Provider business mailing address

3230 SW ARCHER RD APT G136
GAINESVILLE FL
32608-1702
US

V. Phone/Fax

Practice location:
  • Phone: 352-554-2000
  • Fax:
Mailing address:
  • Phone: 352-642-6734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number285888
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: