Provider Demographics
NPI:1326723578
Name:PORCHE, MARQUITA DENISE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:DENISE
Last Name:PORCHE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16750 80TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3174
Mailing Address - Country:US
Mailing Address - Phone:773-368-5619
Mailing Address - Fax:
Practice Address - Street 1:16750 80TH AVE STE D
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3174
Practice Address - Country:US
Practice Address - Phone:773-368-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041372719163W00000X
IL209027519363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily