Provider Demographics
NPI:1932983384
Name:HALL-JETER, ANITRA (LPN)
Entity Type:Individual
Prefix:
First Name:ANITRA
Middle Name:
Last Name:HALL-JETER
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 1:8942 FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-5823
Mailing Address - Country:US
Mailing Address - Phone:727-288-8691
Mailing Address - Fax:
Practice Address - Street 1:8942 FOREST LAKE DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-5823
Practice Address - Country:US
Practice Address - Phone:727-288-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5177337164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse