Healthcare Provider Details

I. General information

NPI: 1245281500
Provider Name (Legal Business Name): MARIE NYNON FLEURGIN AUTONOMOUS-APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 NW 167TH ST
MIAMI FL
33162-3401
US

IV. Provider business mailing address

58 NW 167TH ST
MIAMI FL
33162-3401
US

V. Phone/Fax

Practice location:
  • Phone: 305-956-7787
  • Fax: 305-956-7716
Mailing address:
  • Phone: 305-956-7787
  • Fax: 888-314-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2527972-APRN
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: