Provider Demographics
NPI:1336451848
Name:GULLEY, LAVETTE DENISE
Entity Type:Individual
Prefix:
First Name:LAVETTE
Middle Name:DENISE
Last Name:GULLEY
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 1:15 FIR TRAIL CRSE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-4220
Mailing Address - Country:US
Mailing Address - Phone:352-348-3509
Mailing Address - Fax:800-372-7015
Practice Address - Street 1:116 S MAGNOLIA AVE # 3D
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1178
Practice Address - Country:US
Practice Address - Phone:352-348-3509
Practice Address - Fax:800-372-7015
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 251E00000X, 376K00000X
FL231201372500000X, 372600000X, 376J00000X
FL8672374U00000X
FL110702376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriver
No251E00000XAgenciesHome Health
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0005659Medicaid
FL000565901Medicaid
FL000565900Medicaid