Provider Demographics
NPI:1558164749
Name:IDLEBURGH, SERENA
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:IDLEBURGH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3670
Mailing Address - Country:US
Mailing Address - Phone:863-209-0264
Mailing Address - Fax:
Practice Address - Street 1:526 W 13TH ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3670
Practice Address - Country:US
Practice Address - Phone:863-209-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty