Provider Demographics
NPI:1699470393
Name:GAVIN, LAFREDA DENIECE
Entity type:Individual
Prefix:
First Name:LAFREDA
Middle Name:DENIECE
Last Name:GAVIN
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 1:871 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:FL
Mailing Address - Zip Code:33597-4095
Mailing Address - Country:US
Mailing Address - Phone:352-569-7353
Mailing Address - Fax:
Practice Address - Street 1:871 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:FL
Practice Address - Zip Code:33597-4095
Practice Address - Country:US
Practice Address - Phone:352-569-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide