Provider Demographics
NPI:1568020444
Name:POOLE, TAKAYA ROCHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:TAKAYA
Middle Name:ROCHELLE
Last Name:POOLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TAKAYA
Other - Middle Name:ROCHELLE
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:6920 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-9449
Mailing Address - Country:US
Mailing Address - Phone:352-537-1234
Mailing Address - Fax:
Practice Address - Street 1:6920 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-9449
Practice Address - Country:US
Practice Address - Phone:352-537-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5237105164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse