Provider Demographics
NPI:1740754589
Name:DAKERS, MURIEL
Entity type:Individual
Prefix:
First Name:MURIEL
Middle Name:
Last Name:DAKERS
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 1:6317 NEWTOWN CIR APT B5
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3612
Mailing Address - Country:US
Mailing Address - Phone:813-624-2252
Mailing Address - Fax:
Practice Address - Street 1:6317 NEWTOWN CIR APT B5
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3612
Practice Address - Country:US
Practice Address - Phone:813-624-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0002536003747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000253600Medicaid