Provider Demographics
NPI:1679170559
Name:ROSALES, MARBELLY DANIELA (FNP)
Entity Type:Individual
Prefix:
First Name:MARBELLY
Middle Name:DANIELA
Last Name:ROSALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SW 109TH AVE APT 10C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4430
Mailing Address - Country:US
Mailing Address - Phone:786-417-1729
Mailing Address - Fax:
Practice Address - Street 1:700 CUBA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5951
Practice Address - Country:US
Practice Address - Phone:575-554-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily