Provider Demographics
NPI:1578145389
Name:SEEDEN, PEQUILLA (RN)
Entity Type:Individual
Prefix:MRS
First Name:PEQUILLA
Middle Name:
Last Name:SEEDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 DUNHILL CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2075
Mailing Address - Country:US
Mailing Address - Phone:863-308-7195
Mailing Address - Fax:
Practice Address - Street 1:3434 KNIGHTS STATION RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2517
Practice Address - Country:US
Practice Address - Phone:863-308-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9334857163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9334857OtherRN