Provider Demographics
NPI:1679054134
Name:GREEN, ADRIANE MCFORD
Entity Type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:MCFORD
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 DAFFODIL CIRCLE TALLAHASSEE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305
Mailing Address - Country:US
Mailing Address - Phone:850-322-9900
Mailing Address - Fax:
Practice Address - Street 1:218 DAFFODIL CIRCLE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305
Practice Address - Country:US
Practice Address - Phone:850-322-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906951311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Single Specialty