Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9377480 | FL |
NPI | 1003328600 |
---|---|
Provider Name | Marisol D Casas Buchillon |
First Address | Miami Gardens, FL 33055-2145 |
Second Address | Miami Gardens, FL 33055-2145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2017 |
Last Update Date | 12/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ARNP9377480 | ARNP LICENSE VERIFICATIO (01) | FL |
F10171139 | AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION (01) | FL |