Provider Demographics
NPI:1083286272
Name:POLITE, KENITA BRIANA (CNA)
Entity Type:Individual
Prefix:
First Name:KENITA
Middle Name:BRIANA
Last Name:POLITE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3804
Mailing Address - Country:US
Mailing Address - Phone:386-282-9250
Mailing Address - Fax:
Practice Address - Street 1:1230 ESSEX RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-3804
Practice Address - Country:US
Practice Address - Phone:386-282-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care