Provider Demographics
NPI:1497481659
Name:ALFONSO GARCIA, MARIELIS (MSN, APRN-FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIELIS
Middle Name:
Last Name:ALFONSO GARCIA
Suffix:
Gender:F
Credentials:MSN, APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 NW 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1105
Mailing Address - Country:US
Mailing Address - Phone:863-447-5909
Mailing Address - Fax:
Practice Address - Street 1:3354 NW 38TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1105
Practice Address - Country:US
Practice Address - Phone:863-447-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily