Provider Demographics
NPI:1679670269
Name:FOUCAULD, FLORENCE (MD)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:FOUCAULD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 NE 163RD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 NE 163RD ST STE 203
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4927
Practice Address - Country:US
Practice Address - Phone:305-246-4607
Practice Address - Fax:305-248-4715
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7025143OtherSUNCOAST HEALTH PLAN
FL273097900Medicaid
FL300452OtherAMERIGROUP
FLSG080232OtherVISTA
FL302629OtherAV-MED
FL321968OtherWELLCARE HEALTH PLAN
FL7921686OtherPREFERRED MEDICAL PLAN
FLM921683OtherPREFERRED CARE NETWORK
FL0001114328OtherHUMANA
FL180920OtherJMH
FL273097902OtherMEDICAID
FL180920OtherJMH