MEDICARE: MISS MARIANNETTE PLAZA NP

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	363L00000X	Nurse Practitioner	APRN9408302	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477535144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIANNETTE PLAZA NP

Provider Business Mailing Address
First Line	:	2600 S DOUGLAS RD STE 308
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6134
Country	:	US
Telephone Number	:	305-913-9454
Fax Number	:	305-442-1198

Provider Business Practice Location Address
First Line	:	127 RIDGE CENTER DR
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-6401
Country	:	US
Telephone Number	:	863-421-7400
Fax Number	:

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	06/18/2024

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