Provider Demographics
NPI:1346816220
Name:FAUCETT, MARIBELLE ANNE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIBELLE
Middle Name:ANNE
Last Name:FAUCETT
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:MARIBELLE
Other - Middle Name:ANNE
Other - Last Name:MULLEN PACHECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S STE 103
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 MISSILE AVE
Practice Address - Street 2:
Practice Address - City:MINOT AFB
Practice Address - State:ND
Practice Address - Zip Code:58705-5003
Practice Address - Country:US
Practice Address - Phone:701-723-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181488363LW0102X
FL11018034363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health