Provider Demographics
NPI:1629540018
Name:MCFARLANE, MARVIA
Entity type:Individual
Prefix:
First Name:MARVIA
Middle Name:
Last Name:MCFARLANE
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 1:372 SW TODD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3061
Mailing Address - Country:US
Mailing Address - Phone:772-237-5165
Mailing Address - Fax:772-353-5703
Practice Address - Street 1:372 SW TODD AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3061
Practice Address - Country:US
Practice Address - Phone:772-237-5165
Practice Address - Fax:772-353-5703
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12687310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL12687OtherASSISTED LIVING FACILITY