Provider Demographics
NPI:1689176893
Name:NEVIASER, MARIE CAROLLE
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:CAROLLE
Last Name:NEVIASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:CAROLLE
Other - Last Name:BEAUVAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:442 NE 210TH CIRCLE TER BLDG 5-203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1826
Mailing Address - Country:US
Mailing Address - Phone:786-514-7334
Mailing Address - Fax:
Practice Address - Street 1:442 NE 210TH CIRCLE TER BLDG 5-203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-1826
Practice Address - Country:US
Practice Address - Phone:786-514-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-03
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9336470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily