Provider Demographics
NPI:1043298763
Name:AHRENDTS, MARIE (PA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:AHRENDTS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 SW 148TH AVE
Mailing Address - Street 2:APT #1510
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:EMERGENCY MEDICINE SPECIALISTS OF SOUTH FLORIDA
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:305-835-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292233900Medicaid
FLQ54916Medicare UPIN
FLU6199YMedicare PIN
FLU6199ZMedicare PIN