Provider Demographics
NPI:1427374784
Name:ALTIDOR, MARIE NADINE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:NADINE
Last Name:ALTIDOR
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 1:700 S ROYAL POINCIANA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6600
Mailing Address - Country:US
Mailing Address - Phone:305-637-6400
Mailing Address - Fax:305-835-1598
Practice Address - Street 1:5361 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-8035
Practice Address - Country:US
Practice Address - Phone:305-637-6400
Practice Address - Fax:305-835-1598
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9222154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002187500Medicaid
FL002187500Medicaid