Provider Demographics
NPI:1487001335
Name:FLORIAL, ERTHA
Entity Type:Individual
Prefix:
First Name:ERTHA
Middle Name:
Last Name:FLORIAL
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 1:6523 KRISTIN CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5942
Mailing Address - Country:US
Mailing Address - Phone:407-953-6407
Mailing Address - Fax:
Practice Address - Street 1:6523 KRISTIN CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-5942
Practice Address - Country:US
Practice Address - Phone:407-953-6407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5209351164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse