Provider Demographics
NPI:1154937969
Name:GRICE VELAZQUEZ, LASHONDA
Entity type:Individual
Prefix:MRS
First Name:LASHONDA
Middle Name:
Last Name:GRICE VELAZQUEZ
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:PO BOX 1563
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-1563
Mailing Address - Country:US
Mailing Address - Phone:386-227-3255
Mailing Address - Fax:386-328-7460
Practice Address - Street 1:702 N 19TH ST
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3070
Practice Address - Country:US
Practice Address - Phone:386-227-3255
Practice Address - Fax:386-328-7460
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 374U00000X, 376J00000X
FL305184376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide