Provider Demographics
NPI:1205590809
Name:VEGA ALFONSO, NEREYDA C
Entity type:Individual
Prefix:
First Name:NEREYDA
Middle Name:C
Last Name:VEGA ALFONSO
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 1:19451 S TAMIAMI TRL STE 12
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4815
Mailing Address - Country:US
Mailing Address - Phone:239-299-9787
Mailing Address - Fax:239-291-5756
Practice Address - Street 1:19451 S TAMIAMI TRL STE 12
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4815
Practice Address - Country:US
Practice Address - Phone:239-299-9787
Practice Address - Fax:239-291-5756
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237857376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker