Healthcare Provider Details

I. General information

NPI: 1639083686
Provider Name (Legal Business Name): MARIA DOLORES BOUCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907 NW 43RD ST
GAINESVILLE FL
32606-2006
US

IV. Provider business mailing address

1309 SW 136TH PL
MICANOPY FL
32667-3701
US

V. Phone/Fax

Practice location:
  • Phone: 352-372-0047
  • Fax: 352-372-4701
Mailing address:
  • Phone: 352-372-0047
  • Fax: 352-372-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: