Provider Demographics
NPI:1881305266
Name:DEMARION, ROSALIA MAGDALINA (CNA -BA)
Entity type:Individual
Prefix:
First Name:ROSALIA
Middle Name:MAGDALINA
Last Name:DEMARION
Suffix:
Gender:F
Credentials:CNA -BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 NORDENDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288-0885
Mailing Address - Country:US
Mailing Address - Phone:941-882-0042
Mailing Address - Fax:
Practice Address - Street 1:22655 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2018
Practice Address - Country:US
Practice Address - Phone:239-351-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool