Provider Demographics
NPI:1598915258
Name:HARRISON-ALBRITTON, ROIQUISTA EWANA (LPN)
Entity Type:Individual
Prefix:
First Name:ROIQUISTA
Middle Name:EWANA
Last Name:HARRISON-ALBRITTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 DR. LASALLE LEFALL
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351
Mailing Address - Country:US
Mailing Address - Phone:850-539-2888
Mailing Address - Fax:850-539-2677
Practice Address - Street 1:278 DR. LASALLE LEFALL
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351
Practice Address - Country:US
Practice Address - Phone:850-539-2888
Practice Address - Fax:850-539-2677
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5144860164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688497196Medicaid