Provider Demographics
NPI:1619384658
Name:NEWTON, AVA JUANITA
Entity Type:Individual
Prefix:MS
First Name:AVA
Middle Name:JUANITA
Last Name:NEWTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AVA
Other - Middle Name:JUANITA
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:10615 S.W 68TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476
Mailing Address - Country:US
Mailing Address - Phone:352-509-7257
Mailing Address - Fax:
Practice Address - Street 1:10615 S.W 68TH TERRACE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476
Practice Address - Country:US
Practice Address - Phone:352-509-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5169716164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse