Provider Demographics
NPI:1225623481
Name:NEALY, VIOLA (SOLO PROPIETOR)
Entity Type:Individual
Prefix:
First Name:VIOLA
Middle Name:
Last Name:NEALY
Suffix:
Gender:F
Credentials:SOLO PROPIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 RESERVE DR APT 1422
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1283
Mailing Address - Country:US
Mailing Address - Phone:850-363-7470
Mailing Address - Fax:
Practice Address - Street 1:3909 RESERVE DR APT 1422
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-1283
Practice Address - Country:US
Practice Address - Phone:850-363-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2369983747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106861800Medicaid