Provider Demographics
NPI:1710538632
Name:IZQUIERDO, MARITZA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:PROF
First Name:MARITZA
Middle Name:
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14213 SW 153RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1029
Mailing Address - Country:US
Mailing Address - Phone:305-773-6823
Mailing Address - Fax:
Practice Address - Street 1:14213 SW 153RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1029
Practice Address - Country:US
Practice Address - Phone:305-773-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily