Provider Demographics
NPI:1497846083
Name:CANELL, MARIE ANGE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ANGE
Last Name:CANELL
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 1:8175 NW 12TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0173
Mailing Address - Fax:305-470-5846
Practice Address - Street 1:8175 NW 12TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1828
Practice Address - Country:US
Practice Address - Phone:786-845-0173
Practice Address - Fax:305-470-5846
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2614632163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303907200Medicaid