# MARK ALEXANDER FONSECA ARNP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760991988
- **Authorized official:** MR. MARK ALEXANDER FONSECA MSN, ARNP, AGPCNP-BC (CCO)
- **Authorized official phone:** (786) 493-6556

## Contact information

- **Practice address:** 51 SW 134TH CT, MIAMI, FL 33184-1177
- **Practice address phone:** (786) 493-6556
- **Mailing address:** 10310 SW 142ND CT, MIAMI, FL 33186-8422
- **Mailing address phone:** (786) 493-6556

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | ARNP9309582 | FL | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | ARNP9309582 | FL | — |

## Other

- **Enumeration date:** 09/20/2017
- **Last updated:** 07/21/2022