Provider Demographics
NPI:1497914980
Name:LLAMIDO, JUANA B
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:B
Last Name:LLAMIDO
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 1:4424 STONEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826
Mailing Address - Country:US
Mailing Address - Phone:407-384-5949
Mailing Address - Fax:407-366-7153
Practice Address - Street 1:4424 STONEFIELD DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4258
Practice Address - Country:US
Practice Address - Phone:407-384-5949
Practice Address - Fax:407-366-7153
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679517096Medicaid