Provider Demographics
NPI:1144772096
Name:FAQUIR, AISSEL (APRN)
Entity Type:Individual
Prefix:MS
First Name:AISSEL
Middle Name:
Last Name:FAQUIR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 BANYAN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2135
Mailing Address - Country:US
Mailing Address - Phone:305-766-0392
Mailing Address - Fax:
Practice Address - Street 1:3801 HOLLYWOOD BLVD STE 250
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6759
Practice Address - Country:US
Practice Address - Phone:954-961-8303
Practice Address - Fax:954-961-8307
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9307358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily