Marisa Licata, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704303831 Issued in MI

Practice address

21734 Malden St
Farmington Hills, MI 48336-6041

Phone

(248) 229-0183

NPI assigned

Sep 24, 2020

Last updated

Apr 7, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Marisa Ventura Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Henry Ford Health St. John Hospital

  dba St John North Shores Hospital

  • Podiatrist
  • Harrison Township, MI
  • NPI 1043478910
  Medicare reassignment NPD
• Henry Ford Health St. John Hospital

  dba Henry Ford St John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088
  NPD
• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1790392603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28050 GRAND RIVER AVE",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483365919",
            "telephone_number": "248-229-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21734 MALDEN ST",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483366041",
            "telephone_number": "248-229-0183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICATA",
        "first_name": "MARISA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-24",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704303831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "VENTURA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristopher Liang
• Kelly Libby
• Noelle Libby
• Natalie Libonati
• Ariella Libove-Goldfarb
• Kathryn Licht
• Alyssa Lichtenwald
• Ana Licona
• Leedor Lieberman
• Michael Brian Lieberman, D.D.S.

• Family Nurse Practitioner in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.