Healthcare Provider Details

I. General information

NPI: 1326959628
Provider Name (Legal Business Name): JERI MARKS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 S ATLANTIC AVE
DAYTONA BEACH FL
32118-7602
US

IV. Provider business mailing address

3929 S PENINSULA DR
WILBUR BY THE SEA FL
32127-6509
US

V. Phone/Fax

Practice location:
  • Phone: 386-872-5442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: