Provider Demographics
NPI:1245709302
Name:COTY, MARIE CARMEL
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:CARMEL
Last Name:COTY
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 1:2548 HAYDEN VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1718
Mailing Address - Country:US
Mailing Address - Phone:352-263-6897
Mailing Address - Fax:
Practice Address - Street 1:2548 HAYDEN VALLEY ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1718
Practice Address - Country:US
Practice Address - Phone:352-263-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL734756Medicaid