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General NPI Number Information
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NPI Number | 1699429142
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Entity Type | Individual
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Provider Name | MARLINE DUCLONA
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Gender | Female
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 701 NE EASTLAKE ST.
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983
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Country | US
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Telephone | 772-240-8088
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Fax | 772-323-0514
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Provider Business Mailing Address
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Address Line | 701 NE EASTLAKE ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1204
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Country | US
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Telephone | 772-240-8088
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Fax | 772-323-0514
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 15-1702
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 15-1702
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License Number State | FL
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