Provider Demographics
NPI:1649685256
Name:WELCOME, MARCEDA
Entity type:Individual
Prefix:
First Name:MARCEDA
Middle Name:
Last Name:WELCOME
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:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-1244
Mailing Address - Country:US
Mailing Address - Phone:352-225-2035
Mailing Address - Fax:352-335-6438
Practice Address - Street 1:17073 S.W. 127TH PLACE
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618
Practice Address - Country:US
Practice Address - Phone:352-225-2035
Practice Address - Fax:352-335-6438
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004411500Medicaid