Provider Demographics
NPI:1841768595
Name:POLYCARPE, WILBERTE AUGUSTA (LPN)
Entity Type:Individual
Prefix:
First Name:WILBERTE
Middle Name:AUGUSTA
Last Name:POLYCARPE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5924
Mailing Address - Country:US
Mailing Address - Phone:561-260-0293
Mailing Address - Fax:
Practice Address - Street 1:232 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-5924
Practice Address - Country:US
Practice Address - Phone:561-260-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5195258164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse