Provider Demographics
NPI:1881589851
Name:MINCEY, MARESHA (BSN-RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MARESHA
Middle Name:
Last Name:MINCEY
Suffix:
Gender:F
Credentials:BSN-RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 CELLO LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0003
Mailing Address - Country:US
Mailing Address - Phone:954-822-8372
Mailing Address - Fax:
Practice Address - Street 1:2816 CELLO LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0003
Practice Address - Country:US
Practice Address - Phone:954-822-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-310925163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant