Healthcare Provider Details

I. General information

NPI: 1093632911
Provider Name (Legal Business Name): MARSHANNA BOYETTE HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 GALE LEMERAND DR FL 4
GAINESVILLE FL
32610-3008
US

IV. Provider business mailing address

PO BOX 100294
GAINESVILLE FL
32610-0294
US

V. Phone/Fax

Practice location:
  • Phone: 386-965-1052
  • Fax:
Mailing address:
  • Phone: 352-273-7660
  • Fax: 352-392-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11050565
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9592766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: