Provider Demographics
NPI:1760783948
Name:CALIXTE, GLADYS LEMORIN (NURSING ASST)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:LEMORIN
Last Name:CALIXTE
Suffix:
Gender:F
Credentials:NURSING ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 SE FALLON DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3162
Mailing Address - Country:US
Mailing Address - Phone:772-626-1963
Mailing Address - Fax:
Practice Address - Street 1:193 SE FALLON DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3162
Practice Address - Country:US
Practice Address - Phone:772-626-1963
Practice Address - Fax:772-343-9778
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA81920376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684098196Medicaid