Provider Demographics
NPI:1821014192
Name:MARRACCINI, LINDA ANN (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:MARRACCINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 SUNSET DR
Mailing Address - Street 2:SUITE 407
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4827
Mailing Address - Country:US
Mailing Address - Phone:305-666-8858
Mailing Address - Fax:305-665-1731
Practice Address - Street 1:6280 SUNSET DR
Practice Address - Street 2:SUITE 407
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4827
Practice Address - Country:US
Practice Address - Phone:305-666-8858
Practice Address - Fax:305-665-1731
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000896OtherNHP
FL216989OtherAVMED
FL95933OtherBLUE CROSS BLUE SHIELD
FLD63665Medicare UPIN
FL95933Medicare PIN