Provider Demographics
NPI:1912133844
Name:AZIE, FLORENCE AGEZIM (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:AGEZIM
Last Name:AZIE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:FLORENCE
Other - Middle Name:AGEZIM
Other - Last Name:DAVID-IBEKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73 HARRY S TRUMAN DR
Mailing Address - Street 2:APT 34
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1040
Mailing Address - Country:US
Mailing Address - Phone:443-928-0335
Mailing Address - Fax:240-241-5543
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:800-465-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR176638163W00000X
DCRN1009938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse