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General NPI Number Information
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NPI Number | 1093106387
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Entity Type | Individual
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Provider Name | NEFERTITI TATE DIRECTOR
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Gender | Female
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 945 25TH DR E STE 1
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City | ELLENTON
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State | FL
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Zip | 34222-2054
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Country | US
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Telephone | 941-981-5342
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Fax | 941-981-5351
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Provider Business Mailing Address
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Address Line | 945 25TH DR E STE 1
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City | ELLENTON
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State | FL
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Zip | 34222-2054
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Country | US
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Telephone | 941-981-5342
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Fax | 941-981-5351
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 233808
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 233808
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License Number State | FL
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