Provider Demographics
NPI:1679842645
Name:DELGADO, MARISOL (BSN)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIA DE LAFUENTE CLORQUIDEA #60 H-4
Mailing Address - Street 2:
Mailing Address - City:TOA ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-667-5919
Mailing Address - Fax:
Practice Address - Street 1:ESTANCIA DE LA FUENTE CALLE ORQUIDEA #60 H-4
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-667-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34516-G363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner