Provider Demographics
NPI:1023657921
Name:ELICE, GERLINE (CNA)
Entity type:Individual
Prefix:MS
First Name:GERLINE
Middle Name:
Last Name:ELICE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 S ALEXANDER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-8418
Mailing Address - Country:US
Mailing Address - Phone:813-999-6335
Mailing Address - Fax:
Practice Address - Street 1:1514 S ALEXANDER ST STE 202
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-8418
Practice Address - Country:US
Practice Address - Phone:813-999-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health