Provider Demographics
NPI:1710308812
Name:ARCHER, ANJUILET A (CNA)
Entity Type:Individual
Prefix:MISS
First Name:ANJUILET
Middle Name:A
Last Name:ARCHER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NE LOBSTER RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1718
Mailing Address - Country:US
Mailing Address - Phone:772-333-8226
Mailing Address - Fax:772-333-2417
Practice Address - Street 1:102 NE LOBSTER RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1718
Practice Address - Country:US
Practice Address - Phone:772-333-8226
Practice Address - Fax:772-333-2417
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906640171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6906640OtherAHCA
FL6906640OtherADULT FAMILY CARE HOME