Provider Demographics
NPI:1831686690
Name:DEMPS, SISSERITTA RENEE
Entity type:Individual
Prefix:MRS
First Name:SISSERITTA
Middle Name:RENEE
Last Name:DEMPS
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 1:524 SW PINCKNEY ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-1964
Mailing Address - Country:US
Mailing Address - Phone:850-973-7966
Mailing Address - Fax:
Practice Address - Street 1:524 SW PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-1964
Practice Address - Country:US
Practice Address - Phone:850-973-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty