Provider Demographics
NPI:1275811747
Name:MINTAH, PRISCILLA (CNA)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MINTAH
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 1:3132 W LAMBRIGHT ST
Mailing Address - Street 2:APT 508
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4762
Mailing Address - Country:US
Mailing Address - Phone:813-843-6167
Mailing Address - Fax:
Practice Address - Street 1:3132 W LAMBRIGHT ST
Practice Address - Street 2:APT 508
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4762
Practice Address - Country:US
Practice Address - Phone:813-843-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231137374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide