Provider Demographics
NPI:1508533944
Name:FRANCO, MARISA BROOKE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:BROOKE
Last Name:FRANCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:BROOKE
Other - Last Name:NEEDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3 DEBBIE CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5601
Mailing Address - Country:US
Mailing Address - Phone:631-873-5532
Mailing Address - Fax:
Practice Address - Street 1:3 DEBBIE CT
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5601
Practice Address - Country:US
Practice Address - Phone:631-873-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program