Provider Demographics
NPI:1649770728
Name:HATIM, MADELINE SMITH (LPN)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:SMITH
Last Name:HATIM
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 1:8709 MANCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-9431
Mailing Address - Country:US
Mailing Address - Phone:850-322-9513
Mailing Address - Fax:
Practice Address - Street 1:8709 MANCHESTER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-9431
Practice Address - Country:US
Practice Address - Phone:850-322-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL755731164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse