Individual
MARCIO LICURGO DE AZEVEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
2910 MAGUIRE RD STE 2002, OCOEE, FL 34761-4742
(239) 690-6906
Mailing address
15024 CHAPTER WAY, WINTER GARDEN, FL 34787-1764
(901) 317-9198
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11029589
FL
Other
Enumeration date
11/08/2023
Last updated
06/13/2024
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