Healthcare Provider Details

I. General information

NPI: 1114793320
Provider Name (Legal Business Name): ALINE DJIADJEU REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 FENNEL SEED WAY
RUSKIN FL
33570-5445
US

IV. Provider business mailing address

3060AVE
RUSKIN FL
33570
US

V. Phone/Fax

Practice location:
  • Phone: 925-393-8005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95352087
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9577755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: