Provider Demographics
NPI:1649763178
Name:SENAT, MARIE ALEXANDRA I (OWNER)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ALEXANDRA
Last Name:SENAT
Suffix:I
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 GRANDIFLORA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7958
Mailing Address - Country:US
Mailing Address - Phone:407-721-5979
Mailing Address - Fax:
Practice Address - Street 1:640 GRANDIFLORA DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811
Practice Address - Country:US
Practice Address - Phone:407-721-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 376J00000X
FL0000000000376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82-2505590OtherTAX ID
FL822505590Medicaid