Provider Demographics
NPI:1225363187
Name:VITALE, MARIELLE FRANCESCA (AA)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:FRANCESCA
Last Name:VITALE
Suffix:
Gender:F
Credentials:AA
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Other - Credentials:
Mailing Address - Street 1:1613 HARRISON PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-514-3960
Practice Address - Street 1:950 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2310
Practice Address - Country:US
Practice Address - Phone:561-391-8300
Practice Address - Fax:954-514-3960
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2021-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAA43367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant