Provider Demographics
NPI:1851967905
Name:LABITZKE, SIRENA JODY (RN)
Entity Type:Individual
Prefix:
First Name:SIRENA
Middle Name:JODY
Last Name:LABITZKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11627 NW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-6518
Mailing Address - Country:US
Mailing Address - Phone:239-309-9476
Mailing Address - Fax:
Practice Address - Street 1:2300 N COMMERCE PKWY STE 206
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3256
Practice Address - Country:US
Practice Address - Phone:954-217-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9333404163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse