Provider Demographics
NPI:1215510144
Name:HERARD, ENOCK
Entity type:Individual
Prefix:
First Name:ENOCK
Middle Name:
Last Name:HERARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 SW BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4351
Mailing Address - Country:US
Mailing Address - Phone:772-209-2368
Mailing Address - Fax:
Practice Address - Street 1:2026 SW BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4351
Practice Address - Country:US
Practice Address - Phone:772-209-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW356632390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program