Provider Demographics
NPI:1295328615
Name:ARISTICA, MARIUSKA
Entity type:Individual
Prefix:
First Name:MARIUSKA
Middle Name:
Last Name:ARISTICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4840
Mailing Address - Country:US
Mailing Address - Phone:305-609-3300
Mailing Address - Fax:
Practice Address - Street 1:10887 NW 17TH ST UNIT 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-2044
Practice Address - Country:US
Practice Address - Phone:786-359-4999
Practice Address - Fax:786-359-4843
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9471623163W00000X
FL11016909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse