Provider Demographics
NPI:1235813817
Name:DOUGLAS, SACRINE L
Entity Type:Individual
Prefix:MRS
First Name:SACRINE
Middle Name:L
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SACRINE
Other - Middle Name:L
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2839 HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1856
Mailing Address - Country:US
Mailing Address - Phone:850-272-8793
Mailing Address - Fax:
Practice Address - Street 1:2839 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1856
Practice Address - Country:US
Practice Address - Phone:850-272-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health