Healthcare Provider Details

I. General information

NPI: 1417374083
Provider Name (Legal Business Name): MARIE KETTY JUSSOME ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 NW 119TH ST
MIAMI FL
33167-3232
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-5688
  • Fax: 786-761-1263
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9340018
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: