Provider Demographics
NPI:1093923120
Name:ALDRIDGE, JEAN MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:STECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:907 OAK DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2652
Mailing Address - Country:US
Mailing Address - Phone:407-774-4541
Mailing Address - Fax:
Practice Address - Street 1:919 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2101
Practice Address - Country:US
Practice Address - Phone:407-323-4445
Practice Address - Fax:407-321-5276
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1164581633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1164581633OtherCOMMUNITY MENTAL HEALTH