Provider Demographics
NPI:1881829190
Name:KITTY LOUISE TRAVEL NURSE
Entity Type:Organization
Organization Name:KITTY LOUISE TRAVEL NURSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-272-1526
Mailing Address - Street 1:341 HIDDEN PINES CIR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3361
Mailing Address - Country:US
Mailing Address - Phone:407-272-1526
Mailing Address - Fax:
Practice Address - Street 1:341 HIDDEN PINES CIR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3361
Practice Address - Country:US
Practice Address - Phone:407-272-1526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-17
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA0304027251E00000X, 251G00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care