Provider Demographics
NPI:1780559252
Name:MARROQUIN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MARROQUIN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DOLPHIN LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-6541
Mailing Address - Country:US
Mailing Address - Phone:479-388-1736
Mailing Address - Fax:
Practice Address - Street 1:3291 S THOMPSON ST STE A101
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7344
Practice Address - Country:US
Practice Address - Phone:479-388-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2460133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered