Provider Demographics
NPI:1023136561
Name:JUATCO, FLORENTINA ENVERGA (RPH)
Entity type:Individual
Prefix:
First Name:FLORENTINA
Middle Name:ENVERGA
Last Name:JUATCO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 BROOKPLACE DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-6215
Mailing Address - Country:US
Mailing Address - Phone:423-842-8100
Mailing Address - Fax:423-842-0524
Practice Address - Street 1:6300 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5722
Practice Address - Country:US
Practice Address - Phone:423-842-8100
Practice Address - Fax:423-842-0524
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist