Provider Demographics
NPI:1134302110
Name:KING, ANNETTE NADINE
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:NADINE
Last Name:KING
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 1:151 SOUTH MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4958
Mailing Address - Country:US
Mailing Address - Phone:863-675-3314
Mailing Address - Fax:863-675-0978
Practice Address - Street 1:151 SOUTH MISSOURI ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4958
Practice Address - Country:US
Practice Address - Phone:863-675-3314
Practice Address - Fax:863-675-0978
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4901310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility