Provider Demographics
NPI:1669644993
Name:VLADIC, DALE (CRNFA)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:VLADIC
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 INTEGRA SHORES DR UNIT 305
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5567
Mailing Address - Country:US
Mailing Address - Phone:708-790-7333
Mailing Address - Fax:
Practice Address - Street 1:132 INTEGRA SHORES DR UNIT 305
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:847-715-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2560202163WR0006X
IL258819163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant