Provider Demographics
NPI:1528734977
Name:TATE, CURTIESHA LECOLE
Entity type:Individual
Prefix:
First Name:CURTIESHA
Middle Name:LECOLE
Last Name:TATE
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 1:204 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4062
Mailing Address - Country:US
Mailing Address - Phone:772-501-5987
Mailing Address - Fax:
Practice Address - Street 1:845 4TH CT APT 206
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5933
Practice Address - Country:US
Practice Address - Phone:772-501-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility