Provider Demographics
NPI:1770246639
Name:LEE, ERICA D (CNA)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:D
Last Name:LEE
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 1:824 MANATEE AVE W PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-0131
Mailing Address - Country:US
Mailing Address - Phone:941-592-4427
Mailing Address - Fax:
Practice Address - Street 1:6400 MANATEE AVE W STE L106
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2364
Practice Address - Country:US
Practice Address - Phone:941-592-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324069376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty