Provider Demographics
NPI:1316588510
Name:PRIDGEON, SUMMER BROOCK
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:BROOCK
Last Name:PRIDGEON
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 1:857 MA DIXON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-7825
Mailing Address - Country:US
Mailing Address - Phone:850-843-6954
Mailing Address - Fax:
Practice Address - Street 1:857 MA DIXON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-7825
Practice Address - Country:US
Practice Address - Phone:850-843-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty