MEDICARE: MARITESS NABONG APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	APRN001845	NV
2	363LF0000X	Family Nurse Practitioner	APRN001845	NV

General Provider Information

NPI Number	:	1174925788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITESS NABONG APRN

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4517 BLUE DIAMOND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7620
Country	:	US
Telephone Number	:	725-258-2982
Fax Number	:	877-709-4341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	11/17/2025

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