Provider Demographics
NPI:1992303606
Name:REDDICK, TORI VONTRESE (N/A)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:VONTRESE
Last Name:REDDICK
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 MAGNOLIA PRESERVE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-5027
Mailing Address - Country:US
Mailing Address - Phone:863-427-8217
Mailing Address - Fax:
Practice Address - Street 1:4720 MAGNOLIA PRESERVE AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-5027
Practice Address - Country:US
Practice Address - Phone:863-427-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker