Healthcare Provider Details

I. General information

NPI: 1386759611
Provider Name (Legal Business Name): MARIANNE PRINCE RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-2070
  • Fax: 352-271-4574
Mailing address:
  • Phone: 352-336-2070
  • Fax: 352-271-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN405622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: