Provider Demographics
NPI:1689708687
Name:PLACE, PHILOMENA TOBIN (RN)
Entity Type:Individual
Prefix:MRS
First Name:PHILOMENA
Middle Name:TOBIN
Last Name:PLACE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-1261
Mailing Address - Country:US
Mailing Address - Phone:772-794-5446
Mailing Address - Fax:
Practice Address - Street 1:1565 79TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1261
Practice Address - Country:US
Practice Address - Phone:772-794-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1486902163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice