Provider Demographics
NPI:1679142129
Name:MOTHE-GERDINE, FLEURETTE (DSP)
Entity type:Individual
Prefix:
First Name:FLEURETTE
Middle Name:
Last Name:MOTHE-GERDINE
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:FLEURETTE
Other - Middle Name:
Other - Last Name:MOTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DSP
Mailing Address - Street 1:317 LETA ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-4313
Mailing Address - Country:US
Mailing Address - Phone:863-254-8695
Mailing Address - Fax:
Practice Address - Street 1:317 LETA ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4313
Practice Address - Country:US
Practice Address - Phone:863-254-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-20
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care