Provider Demographics
NPI:1306382577
Name:COKE, DELORES ANEITA
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:ANEITA
Last Name:COKE
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 1:8327 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8614
Mailing Address - Country:US
Mailing Address - Phone:754-234-2991
Mailing Address - Fax:
Practice Address - Street 1:8327 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8614
Practice Address - Country:US
Practice Address - Phone:754-234-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL958881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse