Provider Demographics
NPI:1740230986
Name:MARQUEZ, ELSY (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELSY
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16563 NW 83RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3470
Mailing Address - Country:US
Mailing Address - Phone:305-826-3163
Mailing Address - Fax:305-827-9918
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 401-A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-827-9939
Practice Address - Fax:305-827-9918
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100075363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291150700Medicaid