Provider Demographics
NPI:1386605145
Name:CODLING, ALTHEA C (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:ALTHEA
Middle Name:C
Last Name:CODLING
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 SW SOUTH DANVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5929
Mailing Address - Country:US
Mailing Address - Phone:772-621-4381
Mailing Address - Fax:
Practice Address - Street 1:149 SW SOUTH DANVILLE CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5929
Practice Address - Country:US
Practice Address - Phone:772-621-4381
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9202406163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse