Provider Demographics
NPI:1841942703
Name:QUESADA, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:QUESADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16836 SW 137TH AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2409
Mailing Address - Country:US
Mailing Address - Phone:786-907-7965
Mailing Address - Fax:
Practice Address - Street 1:16836 SW 137TH AVE APT 306
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2409
Practice Address - Country:US
Practice Address - Phone:786-907-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily