Provider Demographics
NPI:1326476664
Name:NEIL, KEREN
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:NEIL
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 1:29 PINE COURT LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-9095
Mailing Address - Country:US
Mailing Address - Phone:352-680-0988
Mailing Address - Fax:352-680-0726
Practice Address - Street 1:29 PINE COURT LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-9095
Practice Address - Country:US
Practice Address - Phone:352-680-0988
Practice Address - Fax:352-680-0726
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906378311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024400400Medicaid