Provider Demographics
NPI:1316137425
Name:FORAND, EUGENIA (AP)
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:FORAND
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6389 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-4717
Mailing Address - Country:US
Mailing Address - Phone:386-689-1634
Mailing Address - Fax:
Practice Address - Street 1:6389 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-4717
Practice Address - Country:US
Practice Address - Phone:386-689-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP2367OtherSTATE LICENSE