Healthcare Provider Details

I. General information

NPI: 1659369171
Provider Name (Legal Business Name): MARILYN DELLAGLORIA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 N KENDALL DRIVE SUITE 208
MIAMI FL
33176-1024
US

IV. Provider business mailing address

1065 NE 125TH ST STE 409
NORTH MIAMI FL
33161-5834
US

V. Phone/Fax

Practice location:
  • Phone: 888-852-6672
  • Fax: 305-891-4228
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-891-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP1460542
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberARNP1460542
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP1460542
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP1460542
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP1460542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: