1033516174 NPI number — MISS EVANGELINE QUINES PUZON PT, DPT

Table of content: MISS EVANGELINE QUINES PUZON PT, DPT (NPI 1033516174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033516174 NPI number — MISS EVANGELINE QUINES PUZON PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUZON
Provider First Name:
EVANGELINE
Provider Middle Name:
QUINES
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033516174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 LEXINGTON GREEN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32771-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-688-0070
Provider Business Mailing Address Fax Number:
407-688-0071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1804 OAKLEY SEAVER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-1925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-688-0070
Provider Business Practice Location Address Fax Number:
407-688-0071
Provider Enumeration Date:
12/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  29910 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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