MEDICARE: MARITZA FIESCO ARNP

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	11012261	FL

General Provider Information

NPI Number	:	1992384424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITZA FIESCO ARNP

Provider Business Mailing Address
First Line	:	4180 127TH TRL N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-8943
Country	:	US
Telephone Number	:	407-520-6553
Fax Number	:

Provider Business Practice Location Address
First Line	:	4180 127TH TRL N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-8943
Country	:	US
Telephone Number	:	407-520-6553
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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