Provider Demographics
NPI:1932616299
Name:RIBEIRO, MARCO FELIPE ANTUNES (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MARCO FELIPE
Middle Name:ANTUNES
Last Name:RIBEIRO
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CHURCH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3647
Mailing Address - Country:US
Mailing Address - Phone:860-704-0363
Mailing Address - Fax:860-346-3517
Practice Address - Street 1:85 CHURCH ST STE 600
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3647
Practice Address - Country:US
Practice Address - Phone:860-347-5333
Practice Address - Fax:860-346-3517
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2307343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner