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General NPI Number Information
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NPI Number | 1750132940
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Entity Type | Individual
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Provider Name | TEQUILA MONOA HILL NURSE AIDE
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Gender | Female
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 1045 US HIGHWAY 17 S
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City | BARTOW
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State | FL
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Zip | 33830-6027
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Country | US
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Telephone | 717-331-7371
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 SADDLEWOOD CT
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City | BARTOW
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State | FL
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Zip | 33830-2916
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Country | US
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Telephone | 717-331-7371
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 20012035
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License Number State | PA
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