Provider Demographics
NPI:1033687108
Name:NEGRON, DETSY Z
Entity type:Individual
Prefix:
First Name:DETSY
Middle Name:Z
Last Name:NEGRON
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 1:121 CHAMPIONS VUE LOOP
Mailing Address - Street 2:APT 101
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897
Mailing Address - Country:US
Mailing Address - Phone:939-232-6642
Mailing Address - Fax:
Practice Address - Street 1:121 CHAMPIONS VUE LOOP
Practice Address - Street 2:APT 101
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897
Practice Address - Country:US
Practice Address - Phone:939-232-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9270266163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency