Provider Demographics
NPI:1518525567
Name:WILKERSON, FLORENCE YOUNGBLOOD
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:YOUNGBLOOD
Last Name:WILKERSON
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 1:306 TARPON ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2448
Mailing Address - Country:US
Mailing Address - Phone:407-844-4895
Mailing Address - Fax:
Practice Address - Street 1:306 TARPON ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2448
Practice Address - Country:US
Practice Address - Phone:407-844-4895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide