Provider Demographics
NPI:1598304594
Name:MARRERO, JORGE LUIS (ARNP)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:MARRERO
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 1:2381 SW 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1234
Mailing Address - Country:US
Mailing Address - Phone:305-266-5859
Mailing Address - Fax:
Practice Address - Street 1:8501 SW 124TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4631
Practice Address - Country:US
Practice Address - Phone:786-808-8555
Practice Address - Fax:786-360-1100
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF12190001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109-759-700Medicaid