Provider Demographics
NPI:1922275684
Name:METCALF, VERONICA (LM)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:SCOTTSMOOR
Mailing Address - State:FL
Mailing Address - Zip Code:32775-0169
Mailing Address - Country:US
Mailing Address - Phone:321-289-1899
Mailing Address - Fax:
Practice Address - Street 1:5802 STAMFORD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSMOOR
Practice Address - State:FL
Practice Address - Zip Code:32775
Practice Address - Country:US
Practice Address - Phone:321-289-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW156176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340398000Medicaid