Provider Demographics
NPI:1982273587
Name:MARQUEZ, DAGOBERTO (APRN)
Entity Type:Individual
Prefix:
First Name:DAGOBERTO
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26847 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7524
Mailing Address - Country:US
Mailing Address - Phone:305-285-9352
Mailing Address - Fax:786-404-3604
Practice Address - Street 1:26847 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7524
Practice Address - Country:US
Practice Address - Phone:305-285-9352
Practice Address - Fax:786-404-3604
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013592363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care