Provider Demographics
NPI:1649736745
Name:JUSMA, MARIE ALIENE (APRN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ALIENE
Last Name:JUSMA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 NW 110TH STREET
Mailing Address - Street 2:HOUSE
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168
Mailing Address - Country:US
Mailing Address - Phone:786-439-5422
Mailing Address - Fax:
Practice Address - Street 1:1095 NW 110TH STREET
Practice Address - Street 2:HOUSE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168
Practice Address - Country:US
Practice Address - Phone:786-439-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001088363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ250-54165-871-0Medicaid