Healthcare Provider Details

I. General information

NPI: 1417546177
Provider Name (Legal Business Name): MARISA DIAMOND JURISIC MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 11/05/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 USA HEALTH BLVD.
MOBILE AL
36608-0020
US

IV. Provider business mailing address

PO BOX 21595
BELFAST ME
04915-4112
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-8880
  • Fax: 251-633-2817
Mailing address:
  • Phone: 251-318-2678
  • Fax: 251-405-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-154589
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: