Provider Demographics
NPI:1518182682
Name:CROSS, FLORENCE M (PROVEDER HEALTHCARE)
Entity type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:M
Last Name:CROSS
Suffix:
Gender:F
Credentials:PROVEDER HEALTHCARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4071 ST RT 68
Mailing Address - Street 2:LOT 36
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078
Mailing Address - Country:US
Mailing Address - Phone:937-450-4514
Mailing Address - Fax:
Practice Address - Street 1:4071 ST RT 68
Practice Address - Street 2:LOT 36
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078
Practice Address - Country:US
Practice Address - Phone:937-450-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2362303OtherSTATE PROVIDER #