MEDICARE: MARLINE SUFFRIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	CNA 41651	FL

General Provider Information

NPI Number	:	1346435195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLINE SUFFRIN

Provider Business Mailing Address
First Line	:	1308 GRAND CLUB BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-8133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 GRAND CLUB BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-8133
Country	:	US
Telephone Number	:	772-489-6793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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Directions to “ MARLINE SUFFRIN ” Practice Location

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