Provider Demographics
NPI:1689420093
Name:DUCLONA, MARIE ELPHINE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ELPHINE
Last Name:DUCLONA
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 1:1260 NORTHLAKE BLVD # 1062
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2050
Mailing Address - Country:US
Mailing Address - Phone:561-932-6723
Mailing Address - Fax:
Practice Address - Street 1:1260 NORTHLAKE BLVD # 1062
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2050
Practice Address - Country:US
Practice Address - Phone:561-932-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL567890163WH0200X, 163WR0400X, 163WC1500X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology