Provider Demographics
NPI:1821516444
Name:POWELL-GACHAU, PATRICE
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:POWELL-GACHAU
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 1:1691 GRANDEFLORA AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3471
Mailing Address - Country:US
Mailing Address - Phone:407-738-7141
Mailing Address - Fax:352-394-8767
Practice Address - Street 1:1691 GRANDEFLORA AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:407-738-7141
Practice Address - Fax:352-394-8767
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA257262376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP422815727530OtherFLORIDA DRIVER LICENSE