Provider Demographics
NPI:1255097549
Name:GIVENS, SARAH DANIELLE (LPN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DANIELLE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 JEFFERYSCOT CT
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4204
Mailing Address - Country:US
Mailing Address - Phone:205-441-0470
Mailing Address - Fax:
Practice Address - Street 1:1200 E JAMES LEE BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-3126
Practice Address - Country:US
Practice Address - Phone:850-689-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5226597164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse