Provider Demographics
NPI:1558582718
Name:STAINE, MARINA DIANA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:DIANA
Last Name:STAINE
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 1:7111 ALHAMBRA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5907
Mailing Address - Country:US
Mailing Address - Phone:786-263-5652
Mailing Address - Fax:
Practice Address - Street 1:7000 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-6817
Practice Address - Country:US
Practice Address - Phone:786-263-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1477592363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health