Provider Demographics
NPI:1467236059
Name:MARRIOTT, IVONNE NICOLE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:NICOLE
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:271 NE 38TH ST APT C208
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1438
Mailing Address - Country:US
Mailing Address - Phone:786-709-7899
Mailing Address - Fax:
Practice Address - Street 1:1880 E COMMERCIAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3747
Practice Address - Country:US
Practice Address - Phone:954-776-7755
Practice Address - Fax:954-771-2722
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11028138363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health