Provider Demographics
NPI:1184955866
Name:GARCIA, MARICELA (RN,CNM,APN)
Entity type:Individual
Prefix:MS
First Name:MARICELA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN,CNM,APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7813
Mailing Address - Country:US
Mailing Address - Phone:212-749-1820
Mailing Address - Fax:
Practice Address - Street 1:279 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7813
Practice Address - Country:US
Practice Address - Phone:212-477-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY775154-01163W00000X
IL041338954163W00000X
IL209007998363L00000X
IL209.007998041.338954367A00000X
NYF001968-01367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05941722Medicaid