Healthcare Provider Details

I. General information

NPI: 1376895730
Provider Name (Legal Business Name): MARLENE ADESCA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 NW 40TH AVE STE 200
LAUDERHILL FL
33313-5801
US

IV. Provider business mailing address

1229 NW 40TH AVE APT 4A
LAUDERHILL FL
33313-5801
US

V. Phone/Fax

Practice location:
  • Phone: 954-583-4710
  • Fax: 954-967-8141
Mailing address:
  • Phone: 954-583-4710
  • Fax: 954-583-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN9426132
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9426132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: