Provider Demographics
NPI:1245281500
Name:FLEURGIN, MARIE NYNON (AUTONOMOUS-APRN)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:NYNON
Last Name:FLEURGIN
Suffix:
Gender:F
Credentials:AUTONOMOUS-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3401
Mailing Address - Country:US
Mailing Address - Phone:305-956-7787
Mailing Address - Fax:888-314-7887
Practice Address - Street 1:58 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-3401
Practice Address - Country:US
Practice Address - Phone:305-956-7787
Practice Address - Fax:305-956-7716
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2527972-APRN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306697500Medicaid
FL306697500Medicaid
FLU1414XMedicare PIN
FLP98939Medicare UPIN