Provider Demographics
NPI:1598252942
Name:CUCALON, MARCELA (ARNP)
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:CUCALON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARCELA
Other - Middle Name:
Other - Last Name:CUCALON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:8200 SW 117TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4825
Mailing Address - Country:US
Mailing Address - Phone:305-746-5249
Mailing Address - Fax:
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:STE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183
Practice Address - Country:US
Practice Address - Phone:305-403-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9380821363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9380821Medicaid