Provider Demographics
NPI:1174370464
Name:ETIENNE, ALTAGRACE (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:ALTAGRACE
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7528 ARLINGTON EXPY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7335
Mailing Address - Country:US
Mailing Address - Phone:904-303-3875
Mailing Address - Fax:
Practice Address - Street 1:7528 ARLINGTON EXPY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-7335
Practice Address - Country:US
Practice Address - Phone:904-303-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide