Provider Demographics
NPI:1528662780
Name:GERVACIO, FLOR JATZMIN
Entity type:Individual
Prefix:DR
First Name:FLOR
Middle Name:JATZMIN
Last Name:GERVACIO
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 1:10858 SANDY RUN
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6850
Mailing Address - Country:US
Mailing Address - Phone:561-935-7283
Mailing Address - Fax:
Practice Address - Street 1:14000 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1402
Practice Address - Country:US
Practice Address - Phone:561-622-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist