Provider Demographics
NPI:1700238474
Name:VANDHUYNSLAGER, MARCI (MS)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:VANDHUYNSLAGER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 THATCHER BLVD
Mailing Address - Street 2:
Mailing Address - City:MOORE HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33471
Mailing Address - Country:US
Mailing Address - Phone:863-885-4798
Mailing Address - Fax:
Practice Address - Street 1:832 THATCHER BLVD
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471
Practice Address - Country:US
Practice Address - Phone:863-885-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 12201251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health