Healthcare Provider Details

I. General information

NPI: 1164053633
Provider Name (Legal Business Name): MARIELITA SOTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 BUENAVENTURA BLVD
KISSIMMEE FL
34743-8128
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-344-9959
  • Fax: 833-450-5405
Mailing address:
  • Phone: 321-332-6947
  • Fax: 689-304-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: