Provider Demographics
NPI:1083156152
Name:DE OLIVEIRA, MARCO MARTINS (APRN)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:MARTINS
Last Name:DE OLIVEIRA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 NW 187TH AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5307
Mailing Address - Country:US
Mailing Address - Phone:786-355-5616
Mailing Address - Fax:786-513-3311
Practice Address - Street 1:10885 NW 50TH ST
Practice Address - Street 2:APT 105
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3976
Practice Address - Country:US
Practice Address - Phone:786-355-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9342678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily