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General NPI Number Information
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NPI Number | 1013568138
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Entity Type | Individual
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Provider Name | STANARIA RICHARDSON FLAGG
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Gender | Female
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 7804 W SR
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City | ALACHUA
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State | FL
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Zip | 32615
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Country | US
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Telephone | 386-462-2162
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 822
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City | ALACHUA
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State | FL
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Zip | 32616-0822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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