Provider Demographics
NPI:1154550903
Name:QUEZADA, ELVA NERY (NURSING ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:ELVA
Middle Name:NERY
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:NURSING ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SE 173 ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491
Mailing Address - Country:US
Mailing Address - Phone:352-347-2361
Mailing Address - Fax:
Practice Address - Street 1:2550 SE 173RD ST
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-6073
Practice Address - Country:US
Practice Address - Phone:352-347-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA115859376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide