Provider Demographics
NPI:1184170714
Name:CUNNINGHAM, DARLENE ROLLINS
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:ROLLINS
Last Name:CUNNINGHAM
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 1:716 MARTIN LUTHER KING JR. BLVD.
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351
Mailing Address - Country:US
Mailing Address - Phone:313-701-5785
Mailing Address - Fax:850-627-2630
Practice Address - Street 1:716 MARTIN LUTHER KING JR. BLVD.
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351
Practice Address - Country:US
Practice Address - Phone:313-701-5785
Practice Address - Fax:850-627-2630
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100043096171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor