Provider Demographics
NPI:1184485575
Name:HENRIQUEZ CUETO, MARIA DE LAS MERCEDES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LAS MERCEDES
Last Name:HENRIQUEZ CUETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 NW 83RD DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6243
Mailing Address - Country:US
Mailing Address - Phone:954-868-5554
Mailing Address - Fax:
Practice Address - Street 1:1813 NW 83RD DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6243
Practice Address - Country:US
Practice Address - Phone:954-868-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029668363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care