Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1182842 | FL |
NPI | 1023029808 |
---|---|
Provider Name | Mrs. Marissa Hernandez Sibucao |
First Address | Pembroke Pines, FL 33024-1055 |
Second Address | Miami, FL 33136-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |