Provider Demographics
NPI:1518364363
Name:MARQUES ALONSO, GUSTAVO (ARNP)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:MARQUES ALONSO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 NW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1938
Mailing Address - Country:US
Mailing Address - Phone:786-383-6256
Mailing Address - Fax:
Practice Address - Street 1:711 NW 23RD AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3395
Practice Address - Country:US
Practice Address - Phone:786-383-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS01004081041C0700X
FLARNP9237460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical