Individual provider Active NPI

Marjorie A. D Dimanche, APRN

  • Family Nurse Practitioner
  • Deerfield Beach, FL
National Provider Identifier
1114508538
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11012349 Issued in FL
Practice address
601 E Sample Rd Ste 110
Deerfield Beach, FL 33064-4443
Phone
(954) 783-5151
Fax
(954) 783-0219
NPI assigned
Apr 16, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11012349 FL Primary

Addresses

Primary practice location

601 E Sample Rd Ste 110
Deerfield Beach, FL 33064-4443

Mailing address

601 E Sample Rd Ste 110
Deerfield Beach, FL 33064-4443
Phone (954) 783-5151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11012349FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jean Claude Dubois, P.a. CurrentSince Apr 20, 2021 Accepting new patients
PCC Medical Holdings LLC PastSince Apr 20, 2021 Accepting new patients

Locations

601 E Sample Rd
Ste 110
Deerfield Beach, FL 33064
Phone (954) 783-5151

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1114508538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E SAMPLE RD STE 110",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "330644443",
            "telephone_number": "954-783-5151",
            "fax_number": "954-783-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E SAMPLE RD STE 110",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "330644443",
            "telephone_number": "954-783-5151",
            "fax_number": "954-783-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D DIMANCHE",
        "first_name": "MARJORIE",
        "middle_name": "A.",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-16",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11012349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deerfield Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.