Provider Demographics
NPI:1932836343
Name:DORCELUS, DANE-BERLY (CNA)
Entity Type:Individual
Prefix:
First Name:DANE-BERLY
Middle Name:
Last Name:DORCELUS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 NW 5TH AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2142
Mailing Address - Country:US
Mailing Address - Phone:631-855-8194
Mailing Address - Fax:
Practice Address - Street 1:835 NW 5TH AVE APT 306
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2142
Practice Address - Country:US
Practice Address - Phone:631-855-8194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA400876251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health