Healthcare Provider Details

I. General information

NPI: 1154100790
Provider Name (Legal Business Name): MARLEY LEIGHANN SCHRAMM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 SW 16TH AVE BLDG A
GAINESVILLE FL
32608-1158
US

IV. Provider business mailing address

PO BOX 100296
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-7019
  • Fax:
Mailing address:
  • Phone: 352-627-9350
  • Fax: 352-273-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11028413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: