Provider Demographics
NPI:1467188540
Name:RELIFORD, ATISHA KAYSAN (CNA)
Entity Type:Individual
Prefix:
First Name:ATISHA
Middle Name:KAYSAN
Last Name:RELIFORD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4861 N DIXIE HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3940
Mailing Address - Country:US
Mailing Address - Phone:954-588-6258
Mailing Address - Fax:
Practice Address - Street 1:4861 N DIXIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3940
Practice Address - Country:US
Practice Address - Phone:786-445-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171400000X
FLCNA376604376K00000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No171400000XOther Service ProvidersHealth & Wellness Coach
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCNA376604OtherCERTIFIED NURSING ASSISTANT