Provider Demographics
NPI:1083484042
Name:PRIETO, MADELEINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:PRIETO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 TWEKSBURY TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3410
Mailing Address - Country:US
Mailing Address - Phone:954-478-7031
Mailing Address - Fax:
Practice Address - Street 1:3319 S STATE ROAD 7 STE 202
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8146
Practice Address - Country:US
Practice Address - Phone:561-847-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant