Provider Demographics
NPI:1336805365
Name:TOLES, JERJUAN DEVAR (BSHSM, MSHA)
Entity Type:Individual
Prefix:
First Name:JERJUAN
Middle Name:DEVAR
Last Name:TOLES
Suffix:
Gender:M
Credentials:BSHSM, MSHA
Other - Prefix:
Other - First Name:JERJUAN
Other - Middle Name:DEVAR
Other - Last Name:TOLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSHSM, MSHA
Mailing Address - Street 1:5319 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-5631
Mailing Address - Country:US
Mailing Address - Phone:239-595-9040
Mailing Address - Fax:239-330-7028
Practice Address - Street 1:5319 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-5631
Practice Address - Country:US
Practice Address - Phone:239-595-9040
Practice Address - Fax:239-330-7028
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor