Healthcare Provider Details

I. General information

NPI: 1750820932
Provider Name (Legal Business Name): PROVIESS JILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 LAKE WESTON DR 1516
ORLANDO FL
32810-4492
US

IV. Provider business mailing address

2343 LAKE WESTON DR 1516
ORLANDO FL
32810-4492
US

V. Phone/Fax

Practice location:
  • Phone: 401-327-1354
  • Fax:
Mailing address:
  • Phone: 401-327-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number376K00000X
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number172A0000X
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: