Provider Demographics
NPI:1649527532
Name:MARKETTA, HILARY
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:MARKETTA
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 1:9218 RANDAL PARK BLVD UNIT 4131
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-4920
Mailing Address - Country:US
Mailing Address - Phone:407-615-0566
Mailing Address - Fax:
Practice Address - Street 1:7600 DR PHILLIPS BLVD STE 72
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7238
Practice Address - Country:US
Practice Address - Phone:407-730-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist