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General NPI Number Information
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NPI Number | 1629751136
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Entity Type | Individual
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Provider Name | MARRIA DARDEN
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 1932 HIGHLAND OAKS BLVD
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City | LUTZ
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State | FL
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Zip | 33559-7323
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Country | US
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Telephone | 813-909-1644
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Fax |
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Provider Business Mailing Address
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Address Line | 20648 EVERGREEN CT
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City | DADE CITY
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State | FL
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Zip | 33523-6758
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Country | US
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Telephone | 816-666-0516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CP179248
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License Number State | FL
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