Healthcare Provider Details

I. General information

NPI: 1134005283
Provider Name (Legal Business Name): GRETCHEN PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13963 CADEN GLEN DR
HUDSON FL
34669-5022
US

IV. Provider business mailing address

13963 CADEN GLEN DR
HUDSON FL
34669-5022
US

V. Phone/Fax

Practice location:
  • Phone: 866-634-0120
  • Fax:
Mailing address:
  • Phone: 866-634-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: