Provider Demographics
NPI:1255532735
Name:MARQUEZ, NICOLE AKYAA (LPN)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:AKYAA
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SAVANNAH WAY
Mailing Address - Street 2:201
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3643
Mailing Address - Country:US
Mailing Address - Phone:321-775-4013
Mailing Address - Fax:
Practice Address - Street 1:3000 SAVANNAH WAY
Practice Address - Street 2:201
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3643
Practice Address - Country:US
Practice Address - Phone:321-775-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5151757164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse