Healthcare Provider Details

I. General information

NPI: 1477115293
Provider Name (Legal Business Name): MAGGIE J WASHINGTON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 SUN CITY CENTER BLVD STE 104-1097
RUSKIN FL
33573-6068
US

IV. Provider business mailing address

14710 SCOTTBURGH GLEN DR
WIMAUMA FL
33598-6206
US

V. Phone/Fax

Practice location:
  • Phone: 813-212-7255
  • Fax:
Mailing address:
  • Phone: 813-212-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5170661
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9628770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: