Provider Demographics
NPI:1396028973
Name:OUTAR, MARCIA ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELAINE
Last Name:OUTAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 GEMBROOK CT
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6102
Mailing Address - Country:US
Mailing Address - Phone:561-252-7949
Mailing Address - Fax:561-670-2756
Practice Address - Street 1:1426 RYAN LN
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4018
Practice Address - Country:US
Practice Address - Phone:561-252-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9236955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691692996Medicaid