Provider Demographics
NPI:1902225352
Name:HARRISON, EUGINA K (CNA/HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:EUGINA
Middle Name:K
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CNA/HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7348 COUNTY ROAD 213
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4318
Mailing Address - Country:US
Mailing Address - Phone:352-461-6188
Mailing Address - Fax:
Practice Address - Street 1:602 W CLARKE ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-3019
Practice Address - Country:US
Practice Address - Phone:352-461-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2587112374U00000X
FLCNA187118376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide