Provider Demographics
NPI:1235318551
Name:PHILLIPS, MARCIA S
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:S
Last Name:PHILLIPS
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 1:155 OSCAR BENJAMIN WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-4346
Mailing Address - Country:US
Mailing Address - Phone:850-838-5068
Mailing Address - Fax:850-223-1244
Practice Address - Street 1:155 OSCAR BENJAMIN WAY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-4346
Practice Address - Country:US
Practice Address - Phone:850-838-5068
Practice Address - Fax:850-223-1244
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372500000X, 372600000X, 373H00000X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker