Provider Demographics
NPI:1558855874
Name:DOUGLAS, DENEZE M
Entity Type:Individual
Prefix:
First Name:DENEZE
Middle Name:M
Last Name:DOUGLAS
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 1:7957 ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3561
Mailing Address - Country:US
Mailing Address - Phone:786-985-0690
Mailing Address - Fax:754-888-9175
Practice Address - Street 1:7957 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3561
Practice Address - Country:US
Practice Address - Phone:786-985-0690
Practice Address - Fax:754-888-9175
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24912251E00000X, 372600000X
FL28230253Z00000X
FL302R00000X
FLRAHC113392374U00000X
FL235358376J00000X
FL30212360251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101222400Medicaid
FL111194600Medicaid
FL025122500Medicaid
FL101375000Medicaid