Provider Demographics
NPI:1063817641
Name:GRAHAM, JAMIA PALESTINE ELIZABETH (CNA/HHA)
Entity Type:Individual
Prefix:
First Name:JAMIA
Middle Name:PALESTINE ELIZABETH
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CNA/HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 66TH AVE N
Mailing Address - Street 2:APT.B
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-6154
Mailing Address - Country:US
Mailing Address - Phone:727-565-9607
Mailing Address - Fax:727-828-9330
Practice Address - Street 1:3781 66TH AVE N
Practice Address - Street 2:APT.B
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-6154
Practice Address - Country:US
Practice Address - Phone:727-565-9607
Practice Address - Fax:727-828-9330
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-25
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA205076372500000X, 372600000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide