Provider Demographics
NPI:1295402311
Name:RENTZ-HARRIS, VONDA K
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:K
Last Name:RENTZ-HARRIS
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 1:362 SE PEARL TER
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1869
Mailing Address - Country:US
Mailing Address - Phone:386-365-3343
Mailing Address - Fax:
Practice Address - Street 1:362 SE PEARL TER
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1869
Practice Address - Country:US
Practice Address - Phone:386-365-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker