Healthcare Provider Details

I. General information

NPI: 1386731107
Provider Name (Legal Business Name): MARIAN ELIZABETH PUTTMAN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAN ELIZABETH KING

II. Dates (important events)

Enumeration Date: 10/05/2006
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

PO BOX 168
LAWTEY FL
32058-0168
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone: 904-782-3027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT8045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: