Provider Demographics
NPI:1760234579
Name:SUMERLIN, MARKEETA EDWINA
Entity Type:Individual
Prefix:
First Name:MARKEETA
Middle Name:EDWINA
Last Name:SUMERLIN
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 1:9223 E GULF TO LAKE HWY APT D
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-5373
Mailing Address - Country:US
Mailing Address - Phone:352-422-2589
Mailing Address - Fax:
Practice Address - Street 1:9223 E GULF TO LAKE HWY APT D
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-5373
Practice Address - Country:US
Practice Address - Phone:352-422-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130161376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide