Healthcare Provider Details

I. General information

NPI: 1093187668
Provider Name (Legal Business Name): ERIN DOUCEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 6TH STREET SE
WINTER HAVEN FL
33880-4605
US

IV. Provider business mailing address

1601 SIXTH ST SE
WINTER HAVEN FL
33880-4605
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-9301
  • Fax: 863-419-9304
Mailing address:
  • Phone: 863-419-9301
  • Fax: 863-419-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: