Healthcare Provider Details

I. General information

NPI: 1386605145
Provider Name (Legal Business Name): ALTHEA C CODLING REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 SW SOUTH DANVILLE CIR
PORT SAINT LUCIE FL
34953-5929
US

IV. Provider business mailing address

149 SW SOUTH DANVILLE CIR
PORT SAINT LUCIE FL
34953-5929
US

V. Phone/Fax

Practice location:
  • Phone: 772-621-4381
  • Fax:
Mailing address:
  • Phone: 772-621-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 9202406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: