Provider Demographics
NPI:1588065007
Name:FLORES, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 N 50TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-1872
Mailing Address - Country:US
Mailing Address - Phone:813-626-5690
Mailing Address - Fax:813-621-4285
Practice Address - Street 1:6615 N 50TH ST APT B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-1872
Practice Address - Country:US
Practice Address - Phone:813-626-5690
Practice Address - Fax:813-621-4285
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL280065084343900000X
FLL14000131505111N00000X, 347C00000X
FL471472950111NS0005X, 163WP2201X
FL079497612372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL14000131505OtherMARBELLA MEDICAL TRANSPORT & PRIVATE SERVICES,LLC
FLL14000131505OtherNEW ENROLLMENT