Provider Demographics
NPI:1194570614
Name:VINCENT, ERYKA
Entity type:Individual
Prefix:
First Name:ERYKA
Middle Name:
Last Name:VINCENT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 BRUCE B DOWNS BLVD
Mailing Address - Street 2:STE. 108A #1121
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-3762
Mailing Address - Country:US
Mailing Address - Phone:561-629-4239
Mailing Address - Fax:
Practice Address - Street 1:2653 BRUCE B DOWNS BLVD
Practice Address - Street 2:STE. 108A #1121
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-3762
Practice Address - Country:US
Practice Address - Phone:561-629-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL373H00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist