Healthcare Provider Details

I. General information

NPI: 1154232114
Provider Name (Legal Business Name): MARIE MONIQUE PETIT-DESMANGLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6979 CAMDEN CT
MARGATE FL
33063-8009
US

IV. Provider business mailing address

6979 CAMDEN CT
MARGATE FL
33063-8009
US

V. Phone/Fax

Practice location:
  • Phone: 954-232-6436
  • Fax:
Mailing address:
  • Phone: 54-232-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: