Provider Demographics
NPI:1730381641
Name:QUINTINITA, MARIVIC (DNP)
Entity type:Individual
Prefix:MRS
First Name:MARIVIC
Middle Name:
Last Name:QUINTINITA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S WASHINGTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3500
Mailing Address - Country:US
Mailing Address - Phone:321-385-0884
Mailing Address - Fax:321-385-9578
Practice Address - Street 1:407 S WASHINGTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-385-0884
Practice Address - Fax:321-385-9578
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3088522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily