Provider Demographics
NPI:1871374165
Name:NIEVES, MARISOL LYNETTE (CSFA)
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:LYNETTE
Last Name:NIEVES
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-6864
Mailing Address - Country:US
Mailing Address - Phone:386-334-4181
Mailing Address - Fax:
Practice Address - Street 1:855 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-6864
Practice Address - Country:US
Practice Address - Phone:386-334-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical