Provider Demographics
NPI:1053042424
Name:GREEN, TREMENDEE MONIQUE
Entity Type:Individual
Prefix:
First Name:TREMENDEE
Middle Name:MONIQUE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 PROVIDENCE BLVD # R1074
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7363
Mailing Address - Country:US
Mailing Address - Phone:386-490-5966
Mailing Address - Fax:
Practice Address - Street 1:283 CRANES ROOST BLVD STE 111
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32701-3437
Practice Address - Country:US
Practice Address - Phone:407-451-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL238603376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker