Provider Demographics
NPI:1538779707
Name:LIVINGSTON, ISREAL III
Entity type:Individual
Prefix:PROF
First Name:ISREAL
Middle Name:
Last Name:LIVINGSTON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 SW OVERALL ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-3312
Mailing Address - Country:US
Mailing Address - Phone:850-524-6114
Mailing Address - Fax:
Practice Address - Street 1:173 SW OVERALL ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-3312
Practice Address - Country:US
Practice Address - Phone:850-524-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA72871253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care