Provider Demographics
NPI:1447805270
Name:GREEN, PATRICIA D (LICENSED HOMEMAKER C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:GREEN
Suffix:
Gender:F
Credentials:LICENSED HOMEMAKER C
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOMEMAKER
Mailing Address - Street 1:5753 CROWNTREE LN APT 207
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8054
Mailing Address - Country:US
Mailing Address - Phone:321-362-3936
Mailing Address - Fax:
Practice Address - Street 1:225 PARK TREE TER APT 922
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3468
Practice Address - Country:US
Practice Address - Phone:321-362-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care