Provider Demographics
NPI:1518564426
Name:FLORENCE, TUESDAY
Entity Type:Individual
Prefix:MRS
First Name:TUESDAY
Middle Name:
Last Name:FLORENCE
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 1:1312 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3609
Mailing Address - Country:US
Mailing Address - Phone:816-509-0073
Mailing Address - Fax:
Practice Address - Street 1:1312 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3609
Practice Address - Country:US
Practice Address - Phone:816-509-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13014175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist