Provider Demographics
NPI:1841945102
Name:DEWITT, TERWKO (LPN)
Entity type:Individual
Prefix:
First Name:TERWKO
Middle Name:
Last Name:DEWITT
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 1:1003 N 18TH ST # B-196
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2015
Mailing Address - Country:US
Mailing Address - Phone:407-409-9927
Mailing Address - Fax:
Practice Address - Street 1:1003 N 18TH ST # B-196
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2015
Practice Address - Country:US
Practice Address - Phone:407-409-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5243824164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PN5243824OtherDOH