Provider Demographics
NPI:1790287902
Name:MCDUFFIE, ALPHASICO F (CNA)
Entity Type:Individual
Prefix:
First Name:ALPHASICO
Middle Name:F
Last Name:MCDUFFIE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 BERNARD ST APT A
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-5005
Mailing Address - Country:US
Mailing Address - Phone:321-458-6842
Mailing Address - Fax:877-389-8827
Practice Address - Street 1:746 BERNARD ST APT A
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-5005
Practice Address - Country:US
Practice Address - Phone:321-301-4170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-03
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235160376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker