Healthcare Provider Details

I. General information

NPI: 1386538874
Provider Name (Legal Business Name): NICOLE MARIE MARION RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5902 OLEANDER AVE
FORT PIERCE FL
34982-4002
US

IV. Provider business mailing address

5902 OLEANDER AVE
FORT PIERCE FL
34982-4002
US

V. Phone/Fax

Practice location:
  • Phone: 772-979-0703
  • Fax:
Mailing address:
  • Phone: 772-979-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11046137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: