Healthcare Provider Details

I. General information

NPI: 1831399005
Provider Name (Legal Business Name): MRS. MARSHA LYN KLOPFENSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 BEVILLE RD
SOUTH DAYTONA FL
32119-1951
US

IV. Provider business mailing address

11809 COLONY LAKES BLVD
NEW PORT RICHEY FL
34654-2046
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-7711
  • Fax: 866-426-2811
Mailing address:
  • Phone: 727-856-2706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPT23416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: