Provider Demographics
NPI:1679342075
Name:MARCOS, CAMILA AMANDA (APRN)
Entity type:Individual
Prefix:DR
First Name:CAMILA
Middle Name:AMANDA
Last Name:MARCOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19740 SW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-0602
Mailing Address - Country:US
Mailing Address - Phone:305-967-1822
Mailing Address - Fax:
Practice Address - Street 1:19740 SW 87TH CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-0602
Practice Address - Country:US
Practice Address - Phone:305-967-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL148081367500000X
MDAC006238367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty