Provider Demographics
NPI:1588086169
Name:JOSE DELL
Entity type:Organization
Organization Name:JOSE DELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MELECIO
Authorized Official - Last Name:DELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:PN5171635
Authorized Official - Phone:352-260-7372
Mailing Address - Street 1:14401 NE 153RD AVE.
Mailing Address - Street 2:APT. 21
Mailing Address - City:WALDO
Mailing Address - State:FL
Mailing Address - Zip Code:32694
Mailing Address - Country:US
Mailing Address - Phone:352-260-7372
Mailing Address - Fax:
Practice Address - Street 1:14401 NE 153RD AVE
Practice Address - Street 2:APT. 21
Practice Address - City:WALDO
Practice Address - State:FL
Practice Address - Zip Code:32694-4020
Practice Address - Country:US
Practice Address - Phone:352-260-7372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5171635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty