Provider Demographics
NPI:1346411444
Name:ZINA KISLAOUSKENE
Entity Type:Organization
Organization Name:ZINA KISLAOUSKENE
Other - Org Name:HENRYS AFFORDABLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZINA
Authorized Official - Middle Name:LINA
Authorized Official - Last Name:KISLAOUSKENE
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL NURSE
Authorized Official - Phone:727-549-0489
Mailing Address - Street 1:8206 EAGLES PARK DR N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-7007
Mailing Address - Country:US
Mailing Address - Phone:727-549-0489
Mailing Address - Fax:727-545-9623
Practice Address - Street 1:8206 EAGLES PARK DR N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-7007
Practice Address - Country:US
Practice Address - Phone:727-549-0489
Practice Address - Fax:727-545-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211032251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health