Provider Demographics
NPI:1588127856
Name:BETANCOURT, MARILYN (NP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15201 SW 141ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5686
Mailing Address - Country:US
Mailing Address - Phone:786-768-1283
Mailing Address - Fax:
Practice Address - Street 1:13190 SW 134TH ST STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4460
Practice Address - Country:US
Practice Address - Phone:786-768-1283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9368598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily