Individual
MADELINE FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3521 MACLAY BLVD S, TALLAHASSEE, FL 32312-3913
(850) 431-4872
Mailing address
150 PARKBROOK CIR, TALLAHASSEE, FL 32301-8913
(850) 294-1928
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA56297
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C106Y
BLUECROSS BLUESHIELD OF FLORIDA
FL
Enumeration date
04/22/2010
Last updated
04/22/2010
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