Provider Demographics
NPI:1437781341
Name:ONYANCHA, JUDITH DIANNE
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:DIANNE
Last Name:ONYANCHA
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 1:7252 LUMBER PORT DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-0131
Mailing Address - Country:US
Mailing Address - Phone:813-352-8011
Mailing Address - Fax:
Practice Address - Street 1:7252 LUMBER PORT DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-0131
Practice Address - Country:US
Practice Address - Phone:813-352-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5212405164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse