Individual
CAROLYN L DELOACHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN ARNP
Contact information
Practice address
850 E MAIN ST, LAKE BUTLER, FL 32054-1353
(386) 496-2323
(352) 495-3401
Mailing address
130 SW 123RD ST, NEWBERRY, FL 32669-3005
(352) 332-4541
(352) 495-3401
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1699072
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59-Q22623
CHAMPION
FL
Enumeration date
02/09/2006
Last updated
07/08/2007
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