Individual
MARK ALEXANDER FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN AGPCNP-BC
Contact information
Practice address
51 SW 134TH CT, MIAMI, FL 33184-1177
(786) 493-6556
Mailing address
51 SW 134TH CT, MIAMI, FL 33184-1177
(786) 493-6556
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP9309582
FL
363LG0600X
Gerontology Nurse Practitioner
ARNP9309582
FL
Other
Enumeration date
02/01/2016
Last updated
02/01/2016
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