Provider Demographics
NPI:1851802284
Name:BRANCH, SONYA
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:BRANCH
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 1:616 EMMA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-1418
Mailing Address - Country:US
Mailing Address - Phone:863-513-7873
Mailing Address - Fax:863-606-1420
Practice Address - Street 1:616 EMMA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-1418
Practice Address - Country:US
Practice Address - Phone:863-513-7873
Practice Address - Fax:863-606-1420
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 385H00000X, 376K00000X
FL235948376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022103500Medicaid