Provider Demographics
NPI:1497419642
Name:GIDDENS, OMETRIES D (CNA)
Entity Type:Individual
Prefix:MS
First Name:OMETRIES
Middle Name:D
Last Name:GIDDENS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MS
Other - First Name:OMETRIES
Other - Middle Name:D
Other - Last Name:GIDDENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:705 S BEACH ST APT 45
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5418
Mailing Address - Country:US
Mailing Address - Phone:386-569-6681
Mailing Address - Fax:
Practice Address - Street 1:705 S BEACH ST APT 45
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5418
Practice Address - Country:US
Practice Address - Phone:386-569-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL369956376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide