Provider Demographics
NPI:1114227824
Name:MARKS, TUESDAY L
Entity Type:Individual
Prefix:
First Name:TUESDAY
Middle Name:L
Last Name:MARKS
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 1:712 E COX ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5635
Mailing Address - Country:US
Mailing Address - Phone:386-943-9878
Mailing Address - Fax:
Practice Address - Street 1:712 E COX ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5635
Practice Address - Country:US
Practice Address - Phone:386-943-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372500000X372500000X
374U00000X
FL376J00000X376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684876101Medicaid
FL684876102Medicaid
FL684876196Medicaid