Healthcare Provider Details

I. General information

NPI: 1538074752
Provider Name (Legal Business Name): MICKAELA MARICHAL DNP NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 77TH ST
JACKSON HEIGHTS NY
11372-6651
US

IV. Provider business mailing address

3742 77TH ST
JACKSON HEIGHTS NY
11372-6651
US

V. Phone/Fax

Practice location:
  • Phone: 718-803-3000
  • Fax:
Mailing address:
  • Phone: 718-803-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICKAELA MARICHAL
Title or Position: DERMATOLOGY NURSE PRACTITIONER
Credential: DNP, FNP-BC, DCNP
Phone: 718-803-3000