Provider Demographics
NPI:1952580268
Name:VERNE, MARIE Y JANIA (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:Y JANIA
Last Name:VERNE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 SW 27TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3701
Mailing Address - Country:US
Mailing Address - Phone:786-312-0417
Mailing Address - Fax:
Practice Address - Street 1:823 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5711
Practice Address - Country:US
Practice Address - Phone:305-895-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ64635Medicare UPIN
FLU7032ZMedicare PIN