Provider Demographics
NPI:1487235958
Name:BUONOCORE, MARIELLE CONSTANCE BARCIA (PA-C)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:CONSTANCE BARCIA
Last Name:BUONOCORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIELLE
Other - Middle Name:CONSTANCE BARCIA
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1716 SW 13TH PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-6412
Mailing Address - Country:US
Mailing Address - Phone:239-877-1284
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:12957 PALMS WEST DR STE 102
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4932
Practice Address - Country:US
Practice Address - Phone:561-429-8189
Practice Address - Fax:561-331-8492
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9114290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant