Provider Demographics
NPI:1457917437
Name:HILAIRE BRUNOT, MARCDA ERNEZA (DC,IBCLC)
Entity Type:Individual
Prefix:DR
First Name:MARCDA
Middle Name:ERNEZA
Last Name:HILAIRE BRUNOT
Suffix:
Gender:F
Credentials:DC,IBCLC
Other - Prefix:
Other - First Name:MARCDA
Other - Middle Name:E
Other - Last Name:HILAIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:7952 MALTA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8200
Mailing Address - Country:US
Mailing Address - Phone:561-234-7639
Mailing Address - Fax:
Practice Address - Street 1:7908 BLANDING BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7564
Practice Address - Country:US
Practice Address - Phone:904-720-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-127477174N00000X
FLCH14653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No174N00000XOther Service ProvidersLactation Consultant, Non-RN