Provider Demographics
NPI:1417374083
Name:JUSSOME, MARIE KETTY (ARNP-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:KETTY
Last Name:JUSSOME
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 NE 146TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2343
Mailing Address - Country:US
Mailing Address - Phone:786-274-0615
Mailing Address - Fax:
Practice Address - Street 1:4888 NW 183RD ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2939
Practice Address - Country:US
Practice Address - Phone:305-685-5690
Practice Address - Fax:305-554-8288
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9340018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily