Provider Demographics
NPI:1922610617
Name:NAVARRO, MARQUETTA RENEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:RENEE
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7568
Mailing Address - Country:US
Mailing Address - Phone:317-607-0982
Mailing Address - Fax:
Practice Address - Street 1:602 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3694
Practice Address - Country:US
Practice Address - Phone:317-291-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28203328A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily