Provider Demographics
NPI:1801103221
Name:ALTIERI, MARIE MARTINE (PA-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:MARTINE
Last Name:ALTIERI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 NW 9TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1310
Mailing Address - Country:US
Mailing Address - Phone:954-397-6173
Mailing Address - Fax:
Practice Address - Street 1:1599 NW 9TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1310
Practice Address - Country:US
Practice Address - Phone:561-338-8884
Practice Address - Fax:561-338-5230
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002752700Medicaid
FL002752700Medicaid