Provider Demographics
NPI:1740020973
Name:DUVERGE, THANIA A
Entity type:Individual
Prefix:
First Name:THANIA
Middle Name:A
Last Name:DUVERGE
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 1:3810 DAVIE ROAD EXT UNIT 2307
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1689
Mailing Address - Country:US
Mailing Address - Phone:754-204-4562
Mailing Address - Fax:
Practice Address - Street 1:3810 DAVIE ROAD EXT UNIT 2307
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1689
Practice Address - Country:US
Practice Address - Phone:754-204-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCCHW.0100490172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker