Provider Demographics
NPI:1437984606
Name:DERRICOTTE, JUNNETTE
Entity type:Individual
Prefix:
First Name:JUNNETTE
Middle Name:
Last Name:DERRICOTTE
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 1:83024 SAINT MARK DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6604
Mailing Address - Country:US
Mailing Address - Phone:904-335-1098
Mailing Address - Fax:
Practice Address - Street 1:83024 SAINT MARK DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6604
Practice Address - Country:US
Practice Address - Phone:904-335-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide