Provider Demographics
NPI:1215680103
Name:BOICOURT, DEANNA (RN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:BOICOURT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N CLYDE MORRIS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5532
Mailing Address - Country:US
Mailing Address - Phone:321-439-4174
Mailing Address - Fax:
Practice Address - Street 1:1717 N CLYDE MORRIS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5532
Practice Address - Country:US
Practice Address - Phone:386-274-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1971772163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse