Provider Demographics
NPI:1114141421
Name:BELLUCCIO, MARIA E (RN, AP , DOM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:BELLUCCIO
Suffix:
Gender:F
Credentials:RN, AP , DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 VAN DYKE RD.
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558
Mailing Address - Country:US
Mailing Address - Phone:813-964-0847
Mailing Address - Fax:813-964-0381
Practice Address - Street 1:242 FERN COVE LN
Practice Address - Street 2:
Practice Address - City:GERTON
Practice Address - State:NC
Practice Address - Zip Code:28735-8803
Practice Address - Country:US
Practice Address - Phone:813-649-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC961171100000X
FLAP1690171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist