Provider Demographics
NPI:1124795935
Name:ALLEN, ARTAVIA
Entity type:Individual
Prefix:
First Name:ARTAVIA
Middle Name:
Last Name:ALLEN
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 1:7850 ULMERTON RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4015
Mailing Address - Country:US
Mailing Address - Phone:727-871-4163
Mailing Address - Fax:
Practice Address - Street 1:7850 ULMERTON RD STE 3A
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4015
Practice Address - Country:US
Practice Address - Phone:727-871-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker