Provider Demographics
NPI:1720653348
Name:RAIFORD, SABRINA LATORYA (CNA)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:LATORYA
Last Name:RAIFORD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-4627
Mailing Address - Country:US
Mailing Address - Phone:601-324-1823
Mailing Address - Fax:
Practice Address - Street 1:2218 21ST AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-4627
Practice Address - Country:US
Practice Address - Phone:601-324-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS503747376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide