Provider Demographics
NPI:1952639676
Name:MEDSKER, DORA KAY (CPR/ HIV/HOME HEALTH)
Entity Type:Individual
Prefix:MS
First Name:DORA
Middle Name:KAY
Last Name:MEDSKER
Suffix:
Gender:F
Credentials:CPR/ HIV/HOME HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 ELDRON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4494
Mailing Address - Country:US
Mailing Address - Phone:321-917-7175
Mailing Address - Fax:
Practice Address - Street 1:821 ELDRON BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-4494
Practice Address - Country:US
Practice Address - Phone:321-917-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25120476Medicaid