Healthcare Provider Details

I. General information

NPI: 1962313528
Provider Name (Legal Business Name): MARISA NICOLE MCGRATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16641 WATERS EDGE DR
WESTON FL
33326-1507
US

IV. Provider business mailing address

16641 WATERS EDGE DR
WESTON FL
33326-1507
US

V. Phone/Fax

Practice location:
  • Phone: 954-380-0137
  • Fax:
Mailing address:
  • Phone: 954-380-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: