Provider Demographics
NPI:1346867231
Name:YERKOVICH, FLORAEDEN
Entity Type:Individual
Prefix:
First Name:FLORAEDEN
Middle Name:
Last Name:YERKOVICH
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 1:2102 N CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2216
Mailing Address - Country:US
Mailing Address - Phone:480-668-8324
Mailing Address - Fax:480-668-8328
Practice Address - Street 1:2102 N CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-2216
Practice Address - Country:US
Practice Address - Phone:480-668-8324
Practice Address - Fax:480-668-8328
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL1859376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator