Provider Demographics
NPI:1750718771
Name:NICOLAS, MARIE MANOUCHKA (ARNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:MANOUCHKA
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:MANOUCHKA
Other - Last Name:NICOLAS-VALCIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-756-9977
Mailing Address - Fax:305-756-5757
Practice Address - Street 1:6269 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-4394
Practice Address - Country:US
Practice Address - Phone:305-756-9977
Practice Address - Fax:844-473-2961
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9169790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily