Provider Demographics
NPI:1902624927
Name:DERANCYN, MARIE PAOLA
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:PAOLA
Last Name:DERANCYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 OLD ORANGE PARK RD APT 158
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3029
Mailing Address - Country:US
Mailing Address - Phone:904-437-1533
Mailing Address - Fax:
Practice Address - Street 1:4110 SOUTHPOINT BLVD STE 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0925
Practice Address - Country:US
Practice Address - Phone:866-932-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide