Healthcare Provider Details

I. General information

NPI: 1841176211
Provider Name (Legal Business Name): MARLINA MCMULLIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N PEBBLE CREEK PKWY # 1329
GOODYEAR AZ
85395-2532
US

IV. Provider business mailing address

18382 W COLLEGE DR
GOODYEAR AZ
85395-2686
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-7236
  • Fax:
Mailing address:
  • Phone: 602-730-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: