Individual
MICHELLE MARQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16306 ALLADIN WAY, TAMPA, FL 33624-1105
(813) 610-8687
(813) 962-2970
Mailing address
16306 ALLADIN WAY, TAMPA, FL 33624-1105
(813) 610-8687
(813) 962-2970
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003310400
—
FL
Enumeration date
01/27/2022
Last updated
01/27/2022
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