Provider Demographics
NPI:1467224808
Name:PURICE-ROBERT, KETLEINE
Entity Type:Individual
Prefix:
First Name:KETLEINE
Middle Name:
Last Name:PURICE-ROBERT
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 1:12841 SW 252ND ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:FL
Mailing Address - Zip Code:33032-9175
Mailing Address - Country:US
Mailing Address - Phone:954-854-0496
Mailing Address - Fax:
Practice Address - Street 1:12841 SW 252ND ST UNIT 102
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:FL
Practice Address - Zip Code:33032-9175
Practice Address - Country:US
Practice Address - Phone:954-854-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health