Provider Demographics
NPI:1740986504
Name:BORGES, MARIAM BEATRIZ (PA)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:BEATRIZ
Last Name:BORGES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4000 HOLLYWOOD BLVD STE 215S
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1227
Mailing Address - Country:US
Mailing Address - Phone:954-807-9332
Mailing Address - Fax:
Practice Address - Street 1:7800 SW 57TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5543
Practice Address - Country:US
Practice Address - Phone:305-740-6181
Practice Address - Fax:305-667-4656
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2024-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant