Provider Demographics
NPI:1568975084
Name:HARGROVE, LAVONDA MOORE
Entity Type:Individual
Prefix:MS
First Name:LAVONDA
Middle Name:MOORE
Last Name:HARGROVE
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 1:31733 BAYMONT LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-8156
Mailing Address - Country:US
Mailing Address - Phone:813-606-0488
Mailing Address - Fax:813-428-6689
Practice Address - Street 1:31733 BAYMONT LOOP
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-8156
Practice Address - Country:US
Practice Address - Phone:813-606-0488
Practice Address - Fax:813-428-6689
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist