Provider Demographics
NPI:1912147380
Name:JAIMES, APOLONIA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:APOLONIA
Middle Name:
Last Name:JAIMES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 N ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-2352
Mailing Address - Country:US
Mailing Address - Phone:386-747-6402
Mailing Address - Fax:
Practice Address - Street 1:1231 N ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2352
Practice Address - Country:US
Practice Address - Phone:386-747-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOAT10831314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility