MEDICARE: MARIE IVETA JOSEPH

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11034692	FL

General Provider Information

NPI Number	:	1558193755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE IVETA JOSEPH

Provider Business Mailing Address
First Line	:	111 NW 183RD ST STE 203
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4578
Country	:	US
Telephone Number	:	786-809-4101
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 NW 183RD ST STE 203
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4578
Country	:	US
Telephone Number	:	786-809-4101
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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Directions to “ MARIE IVETA JOSEPH ” Practice Location

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