Healthcare Provider Details

I. General information

NPI: 1366735607
Provider Name (Legal Business Name): FRONT PORCH HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 N KENANSVILLE RD
SAINT CLOUD FL
34773-9109
US

IV. Provider business mailing address

900 FONTANA LN
KENANSVILLE FL
34739-9010
US

V. Phone/Fax

Practice location:
  • Phone: 407-797-3175
  • Fax:
Mailing address:
  • Phone: 407-797-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number851162
License Number StateFL

VIII. Authorized Official

Name: MRS. ARLENE A VICKERS
Title or Position: PRESIDENT
Credential: ARNP
Phone: 407-797-3175