Provider Demographics
NPI:1548781586
Name:MAIQUEZ, COSSETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:COSSETTE
Middle Name:
Last Name:MAIQUEZ
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 1:448 MORGAN CIR S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-7225
Mailing Address - Country:US
Mailing Address - Phone:239-771-9046
Mailing Address - Fax:
Practice Address - Street 1:448 MORGAN CIRCLE SOUTH
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936
Practice Address - Country:US
Practice Address - Phone:239-771-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9231086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily