Provider Demographics
NPI:1760911366
Name:JOSEPH, MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:JOSEPH
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 1:3932 NW 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-8837
Mailing Address - Country:US
Mailing Address - Phone:954-464-9351
Mailing Address - Fax:
Practice Address - Street 1:3932 NW 92ND AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-8837
Practice Address - Country:US
Practice Address - Phone:954-464-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAG02170124164W00000X
FLARNP9187209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse