Provider Demographics
NPI:1053872986
Name:SOLIDE, MARIE E
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:SOLIDE
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 1:1526 SW BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2993
Mailing Address - Country:US
Mailing Address - Phone:954-907-7876
Mailing Address - Fax:
Practice Address - Street 1:1526 SW BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2993
Practice Address - Country:US
Practice Address - Phone:954-907-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator