Provider Demographics
NPI:1902281884
Name:DEREZIL, FRANSISE
Entity Type:Individual
Prefix:MRS
First Name:FRANSISE
Middle Name:
Last Name:DEREZIL
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 1:256 SW MOSELLE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5028
Mailing Address - Country:US
Mailing Address - Phone:718-838-4313
Mailing Address - Fax:772-237-2234
Practice Address - Street 1:256 SW MOSELLE AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5028
Practice Address - Country:US
Practice Address - Phone:718-838-4313
Practice Address - Fax:772-237-2234
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12659374U00000X, 376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No374U00000XNursing Service Related ProvidersHome Health Aide