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General NPI Number Information
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NPI Number | 1780916619
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Entity Type | Organization
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Legal Business Name | MARIE ADDLY CAMBRONNE MD PA
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 1700 SE HILLMOOR DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7539
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Country | US
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Telephone | 772-335-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1277
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City | STUART
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State | FL
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Zip | 34995-1277
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Country | US
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Telephone | 772-335-4000
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Fax |
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Authorized Official
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Title or Position | MD
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Name | MARIE-ADDLY CAMBRONNE
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Credential |
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Telephone | 772-335-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME99143
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License Number State | FL
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