Healthcare Provider Details

I. General information

NPI: 1689420093
Provider Name (Legal Business Name): MARIE ELPHINE DUCLONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 NORTHLAKE BLVD # 1062
LAKE PARK FL
33403-2050
US

IV. Provider business mailing address

1260 NORTHLAKE BLVD # 1062
LAKE PARK FL
33403-2050
US

V. Phone/Fax

Practice location:
  • Phone: 561-932-6723
  • Fax:
Mailing address:
  • Phone: 561-932-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberFL567890
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberFL567890
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberFL567890
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberFL567890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: