Provider Demographics
NPI:1740807981
Name:FERGUSON, FUSCHIA TALIA (LPN)
Entity type:Individual
Prefix:
First Name:FUSCHIA
Middle Name:TALIA
Last Name:FERGUSON
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 1:5937 FOREST HILL BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5580
Mailing Address - Country:US
Mailing Address - Phone:561-891-5659
Mailing Address - Fax:
Practice Address - Street 1:5937 FOREST HILL BLVD APT 206
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-5580
Practice Address - Country:US
Practice Address - Phone:561-891-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-04
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5232089164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse