Provider Demographics
NPI:1881401768
Name:LIMEIRA SEGUNDO, MARCOS ANTONIO (APRN)
Entity type:Individual
Prefix:
First Name:MARCOS ANTONIO
Middle Name:
Last Name:LIMEIRA SEGUNDO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W 300 S STE 250
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4369
Mailing Address - Country:US
Mailing Address - Phone:715-240-0054
Mailing Address - Fax:
Practice Address - Street 1:244 W 300 S STE 250
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4369
Practice Address - Country:US
Practice Address - Phone:715-240-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-14
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12852832-4405363LF0000X
UTF09250223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily