Provider Demographics
NPI:1518687417
Name:ALLSOP, MARIANA LOUISE (A-GNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARIANA
Middle Name:LOUISE
Last Name:ALLSOP
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:LOUISE
Other - Last Name:GOLPHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:475 ATLANTIC AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4383
Practice Address - Country:US
Practice Address - Phone:718-369-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026201363LP2300X
NY311920363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care