Basic Information
| Provider Information | |||||||||
| NPI: | 1942923271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUITRAGO | ||||||||
| FirstName: | MARLENA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MSN, APRN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2545 NE COACHMAN RD APT 75 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337651807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083996819 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10011 SEMINOLE BLVD | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337722539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273932800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2022 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN11021916 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.