Provider Demographics
NPI:1639483050
Name:DULANEY, RAQUEL ANGELINA (LMT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ANGELINA
Last Name:DULANEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 SE 105TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3149
Mailing Address - Country:US
Mailing Address - Phone:352-454-6034
Mailing Address - Fax:
Practice Address - Street 1:2300 S PINE AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5102
Practice Address - Country:US
Practice Address - Phone:352-454-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist