Provider Demographics
NPI:1992582894
Name:HAYNES, MARILYN ELIZABETH (CARE COACH)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CARE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 HOLLYWOOD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7982
Mailing Address - Country:US
Mailing Address - Phone:786-668-3273
Mailing Address - Fax:
Practice Address - Street 1:6100 HOLLYWOOD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-7982
Practice Address - Country:US
Practice Address - Phone:786-668-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach