MEDICARE: MARIE ISME

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	363LF0000X	Family Nurse Practitioner	11006046	FL

General Provider Information

NPI Number	:	1184975070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE ISME

Provider Business Mailing Address
First Line	:	230 NW 53RD S
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2206
Country	:	US
Telephone Number	:	954-245-2399
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 NW 53RD ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3243
Country	:	US
Telephone Number	:	954-245-2399
Fax Number	:

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

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	05/19/2023

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Directions to “ MARIE ISME ” Practice Location

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