Provider Demographics
NPI:1700103363
Name:VARGHESE, ANNAMMA (LPN)
Entity Type:Individual
Prefix:
First Name:ANNAMMA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SHANNON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5664
Mailing Address - Country:US
Mailing Address - Phone:407-334-6328
Mailing Address - Fax:
Practice Address - Street 1:138 SHANNON OAKS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-5664
Practice Address - Country:US
Practice Address - Phone:407-334-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5190201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPN 5190201OtherLPN LICENSE