Provider Demographics
NPI:1306361449
Name:FLORENCE, DANA (RN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30298-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1174 FOREST PKWY
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:GA
Practice Address - Zip Code:30260-3471
Practice Address - Country:US
Practice Address - Phone:678-878-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163879163WH0200X, 163WH0500X, 163WI0500X, 163W00000X
251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Single Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care