Provider Demographics
NPI:1588089411
Name:MARRERO, MAYRA C (ARNP)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:C
Last Name:MARRERO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 NW 27TH AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2157
Mailing Address - Country:US
Mailing Address - Phone:305-635-7710
Mailing Address - Fax:305-637-8122
Practice Address - Street 1:1490 NW 27TH AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2157
Practice Address - Country:US
Practice Address - Phone:305-635-7710
Practice Address - Fax:305-637-8122
Is Sole Proprietor?:No
Enumeration Date:2014-03-01
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9339298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010740700Medicaid