Provider Demographics
NPI:1720566599
Name:DI MARE, MABEL (ARNP)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:DI MARE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10975 SW 174TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4063
Mailing Address - Country:US
Mailing Address - Phone:786-389-4156
Mailing Address - Fax:305-964-5200
Practice Address - Street 1:4445 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7189
Practice Address - Country:US
Practice Address - Phone:305-558-8687
Practice Address - Fax:305-558-8097
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9233005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily