Provider Demographics
NPI:1922647361
Name:PLAZZ, GERHONDA WANISE
Entity Type:Individual
Prefix:
First Name:GERHONDA
Middle Name:WANISE
Last Name:PLAZZ
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 1:2935 HOLLY POINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3508
Mailing Address - Country:US
Mailing Address - Phone:904-651-1177
Mailing Address - Fax:
Practice Address - Street 1:2935 HOLLY POINT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3508
Practice Address - Country:US
Practice Address - Phone:904-651-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002327300Medicaid