Provider Demographics
NPI:1538464540
Name:DELGADO, FELICIA DIANA
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:DIANA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:FELICIA
Other - Middle Name:DIANA
Other - Last Name:TRIBBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:508 ISLAMORADA DR S
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-4254
Mailing Address - Country:US
Mailing Address - Phone:904-566-6302
Mailing Address - Fax:904-259-0552
Practice Address - Street 1:508 ISLAMORADA DR S
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-4254
Practice Address - Country:US
Practice Address - Phone:904-566-6302
Practice Address - Fax:904-259-0552
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL641117376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide