Provider Demographics
NPI:1669877239
Name:METELLUS, MARIE DENISE
Entity type:Individual
Prefix:
First Name:MARIE DENISE
Middle Name:
Last Name:METELLUS
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 1:2065 SW 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4492
Mailing Address - Country:US
Mailing Address - Phone:954-609-5043
Mailing Address - Fax:
Practice Address - Street 1:2065 SW 166TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4492
Practice Address - Country:US
Practice Address - Phone:954-609-5043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9235768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily