Provider Demographics
NPI:1881254712
Name:PAUL, CLAUDETTE
Entity type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:
Last Name:PAUL
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 1:4103 DAY BRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-7236
Mailing Address - Country:US
Mailing Address - Phone:941-580-1885
Mailing Address - Fax:
Practice Address - Street 1:4103 DAY BRIDGE PL
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-7236
Practice Address - Country:US
Practice Address - Phone:941-580-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906993311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6906993OtherADULT FAMILY CARE HOME LICENSE