Green, Etheldra A

Green, Etheldra A is an individual health care provider with primary practice located at 10611 Nw Sr 20 , Bristol FL 32321-3232. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Green, Etheldra A can be contacted via phone (850) 643-1033.

Contact Information

Primary practice address
10611 Nw Sr 20 Bristol FL 32321-3232
Phone: (850) 643-1033
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X ISW13573 Florida

Profile Details

NPI number 1467094128
LBN Legal business name Green, Etheldra A
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 15th, 2019
Last updated Oct 15th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467094128 NPPES
Florida Other ISW13573 STATE OF FLORIDA DOH

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