Provider Demographics
NPI:1275356370
Name:LIGHT, EMILY JANE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:LIGHT
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 1:887 GAZEBO CIR APT 6208
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-5240
Mailing Address - Country:US
Mailing Address - Phone:321-313-0267
Mailing Address - Fax:
Practice Address - Street 1:5545 N WICKHAM RD STE 110
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7323
Practice Address - Country:US
Practice Address - Phone:321-779-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9609842163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse