Provider Demographics
NPI:1386029452
Name:PLACIDE, HERMIDE
Entity type:Individual
Prefix:
First Name:HERMIDE
Middle Name:
Last Name:PLACIDE
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 1:15145 MICHELANGELO BLVD
Mailing Address - Street 2:202
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-6019
Mailing Address - Country:US
Mailing Address - Phone:561-306-4972
Mailing Address - Fax:
Practice Address - Street 1:15145 MICHELANGELO BLVD
Practice Address - Street 2:202
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-6019
Practice Address - Country:US
Practice Address - Phone:561-306-4972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3085032363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5085032OtherN/A