Healthcare Provider Details

I. General information

NPI: 1528704681
Provider Name (Legal Business Name): NANNETTE E LIVERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14184 SE 200TH CT
UMATILLA FL
32784-8246
US

IV. Provider business mailing address

14184 SE 200TH CT
UMATILLA FL
32784-8246
US

V. Phone/Fax

Practice location:
  • Phone: 904-735-3970
  • Fax:
Mailing address:
  • Phone: 904-735-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: