Healthcare Provider Details

I. General information

NPI: 1174153654
Provider Name (Legal Business Name): MARINA FOLLICK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4207
US

IV. Provider business mailing address

3425 S SAXXON RD
SAINT AUGUSTINE FL
32092-3000
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax:
Mailing address:
  • Phone: 904-673-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9336716
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11006090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: