Provider Demographics
NPI:1053586255
Name:HERRERA, MARISA ANN (NP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ANN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:BARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4905 HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-9763
Mailing Address - Country:US
Mailing Address - Phone:231-655-3284
Mailing Address - Fax:231-655-5040
Practice Address - Street 1:4905 HARVEY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-9763
Practice Address - Country:US
Practice Address - Phone:231-655-3284
Practice Address - Fax:231-655-5040
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704233226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP32930301Medicare PIN
MIN49800009Medicare PIN