Provider Demographics
NPI: | 1609027911 |
---|---|
Name: | ANA MARQUES P.A. |
Entity Type: | Organization |
Organization Name: | ANA MARQUES P.A. |
Other - Org Name: | LACE MEDICAL SERVICES LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | ANA |
Authorized Official - Middle Name: | PAULA |
Authorized Official - Last Name: | MARQUES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | APRN-C |
Authorized Official - Phone: | 407-460-3558 |
Mailing Address - Street 1: | 17 18 OAK BREEZE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | KISSIMMEE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34744 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 407-460-3558 |
Mailing Address - Fax: | 321-785-1299 |
Practice Address - Street 1: | 17 18 OAK BREEZE AVE |
Practice Address - Street 2: | |
Practice Address - City: | KISSIMMEE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34744 |
Practice Address - Country: | US |
Practice Address - Phone: | 407-460-3558 |
Practice Address - Fax: | 321-785-1299 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ANA MARQUES P.A. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2008-10-06 |
Last Update Date: | 2020-01-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X, 103K00000X, 104100000X, 106H00000X, 171M00000X, 207R00000X, 208D00000X, 225X00000X, 363L00000X, 363LG0600X | ||
FL | 207Q00000X, 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 000497400 | Medicaid | |
FL | 000497400 | Medicaid |