Marisa Licata, NP in Farmington Hills, MI - Medicare Nurse Practitioner

Marisa Licata, NP is a medicare enrolled "Nurse Practitioner - Family" in Farmington Hills, Michigan. Her current practice location is 21734 Malden St, Farmington Hills, Michigan. You can reach out to her office (for appointments etc.) via phone at (248) 229-0183.

Marisa Licata is licensed to practice in Michigan (license number 4704303831) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1790392603.

Contact Information

	Marisa Licata, NP
	21734 Malden St, Farmington Hills, MI 48336-6041
	(248) 229-0183
	Not Available

Map and Direction

Provider's Profile

Full Name	Marisa Licata
Gender	Female
Speciality	Nurse Practitioner - Family
Location	21734 Malden St, Farmington Hills, Michigan
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1790392603
Provider Enumeration Date: 09/24/2020
Last Update Date: 04/07/2025

Medicare PECOS Information:

PECOS PAC ID: 8224419684
Enrollment ID: I20220715001265

Medical Identifiers

Medical identifiers for Marisa Licata such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1790392603	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	4704303831 (Michigan)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Marisa Licata allows following entities to bill medicare on her behalf.

Entity Name	Ascension St John Hospital
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1043478910 PECOS PAC ID: 3173424082 Enrollment ID: O20040115000409

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Marisa Licata is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Marisa Licata, NP 28050 Grand River Ave, Farmington Hills, MI 48336-5919 Ph: (248) 229-0183	Marisa Licata, NP 21734 Malden St, Farmington Hills, MI 48336-6041 Ph: (248) 229-0183

Reviews and Comments

Nurse Practitioner Nurses in Farmington Hills, MI

Juan Huang, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 28050 Grand River Ave, Farmington Hills, MI 48336 Phone: 313-618-9128
Lindsey Rae Harris, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 28050 Grand River Ave, Farmington Hills, MI 48336 Phone: 313-618-9128
Aimee Susan Kantzler, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 28595 Orchard Lake Rd Ste 200, Farmington Hills, MI 48334 Phone: 248-553-0010 Fax: 248-553-5957
Tamika Davis, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 32605 W 12 Mile Rd Ste 195, Farmington Hills, MI 48334 Phone: 313-306-2023 Fax: 888-442-6976
Jasjit Kaur Pataria, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 31500 W 13 Mile Rd Ste 100, Farmington Hills, MI 48334 Phone: 248-509-4070 Fax: 248-509-4080
Mrs. Reba Elsa Issac, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 21141 Middlebelt Rd, Farmington Hills, MI 48336 Phone: 248-477-7022 Fax: 248-477-9370
Mrs. Soni Anil, RN,MSN, PMHNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 37353 Chesapeake Rd, Farmington Hills, MI 48335 Phone: 248-702-8354

Marisa Licata, NP - Medicare Nurse Practitioner in Farmington Hills, MI