Provider Demographics
NPI:1457648107
Name:MARRERO, ENGELBERT (ARNP PMHNP-BC, RN)
Entity Type:Individual
Prefix:MR
First Name:ENGELBERT
Middle Name:
Last Name:MARRERO
Suffix:
Gender:M
Credentials:ARNP PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 W PHALEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-5986
Mailing Address - Country:US
Mailing Address - Phone:602-718-7637
Mailing Address - Fax:
Practice Address - Street 1:15015 W BELL RD STE 101114
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3214
Practice Address - Country:US
Practice Address - Phone:623-269-4870
Practice Address - Fax:623-269-4871
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP252593363LP0808X, 363LP0808X
FLRN9306156163W00000X
FLAL23362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ252593OtherARIZONA BOARD OF NURSING