Provider Demographics
NPI:1376895730
Name:ADESCA, MARLENE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:ADESCA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 NW 40TH AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5801
Mailing Address - Country:US
Mailing Address - Phone:954-583-4710
Mailing Address - Fax:954-583-4711
Practice Address - Street 1:3710 SW 61ST AVE APT 4A
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-2556
Practice Address - Country:US
Practice Address - Phone:954-200-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9426132363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology