Provider Demographics
NPI:1023029808
Name:SIBUCAO, MARISSA HERNANDEZ (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:HERNANDEZ
Last Name:SIBUCAO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1938 NW 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1055
Mailing Address - Country:US
Mailing Address - Phone:954-322-7926
Mailing Address - Fax:954-322-7926
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-6625
Practice Address - Fax:305-585-1991
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1182842363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care