Provider Demographics
NPI:1871159418
Name:MAYORQUIN, ANGIE (ARNP)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:MAYORQUIN
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 1:18112 SW 148TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1856
Mailing Address - Country:US
Mailing Address - Phone:954-205-4139
Mailing Address - Fax:
Practice Address - Street 1:801 S UNIVERSITY DR STE C136
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3366
Practice Address - Country:US
Practice Address - Phone:954-205-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001986363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner