Provider Demographics
NPI:1558739243
Name:JAMIL, ERRICA
Entity Type:Individual
Prefix:
First Name:ERRICA
Middle Name:
Last Name:JAMIL
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 1:903 LAKE LILY DR
Mailing Address - Street 2:B305
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7603
Mailing Address - Country:US
Mailing Address - Phone:321-279-0160
Mailing Address - Fax:
Practice Address - Street 1:903 LAKE LILY DR
Practice Address - Street 2:B305
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7603
Practice Address - Country:US
Practice Address - Phone:321-279-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3460374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3460OtherHOME HEALTH AIDE