Provider Demographics
NPI:1750868659
Name:SWABY, KEZIAH
Entity type:Individual
Prefix:
First Name:KEZIAH
Middle Name:
Last Name:SWABY
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 1:322 SW SOUTH QUICK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7640
Mailing Address - Country:US
Mailing Address - Phone:772-785-5785
Mailing Address - Fax:772-785-5790
Practice Address - Street 1:322 SW SOUTH QUICK CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7640
Practice Address - Country:US
Practice Address - Phone:772-785-5785
Practice Address - Fax:772-785-5790
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9276977163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse