Provider Demographics
NPI:1790127793
Name:TIMOGENE, MARIE MONA
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MONA
Last Name:TIMOGENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:MONA
Other - Last Name:TIMOGENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AFCH
Mailing Address - Street 1:2933 COTTAGEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9791
Mailing Address - Country:US
Mailing Address - Phone:386-259-4435
Mailing Address - Fax:
Practice Address - Street 1:2933 COTTAGEVILLE ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9791
Practice Address - Country:US
Practice Address - Phone:386-259-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906574372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion