Provider Demographics
NPI:1699429142
Name:DUCLONA, MARLINE
Entity type:Individual
Prefix:
First Name:MARLINE
Middle Name:
Last Name:DUCLONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLINE
Other - Middle Name:
Other - Last Name:CHARITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 NE EASTLAKE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1204
Mailing Address - Country:US
Mailing Address - Phone:772-240-8088
Mailing Address - Fax:772-323-0514
Practice Address - Street 1:701 NE EASTLAKE ST.
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-240-8088
Practice Address - Fax:772-323-0514
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-1702372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion