Individual
DANIELLE A. BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1220 N HIGHWAY A1A STE 147, INDIALANTIC, FL 32903-2858
(321) 242-8790
(321) 242-1541
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 242-8790
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
ME82139
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2599246
AETNA
FL
01
—
51172
FLORIDA BLUE (BCBS OF FL)
FL
01
—
5481530001
CIGNA
FL
01
—
P01164038
RR MEDICARE
FL
Enumeration date
09/06/2005
Last updated
06/21/2018
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