Provider Demographics
NPI:1447831144
Name:STOCKER, DEMETRIA DOROTHY
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:DOROTHY
Last Name:STOCKER
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 1:4585 SE 61ST ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-7758
Mailing Address - Country:US
Mailing Address - Phone:352-875-4969
Mailing Address - Fax:
Practice Address - Street 1:4585 SE 61ST ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-7758
Practice Address - Country:US
Practice Address - Phone:352-875-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL108498376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide