Healthcare Provider Details

I. General information

NPI: 1134282296
Provider Name (Legal Business Name): MARLA D GOLDEN DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY SUITE 1404
JACKSONVILLE FL
32216-6282
US

IV. Provider business mailing address

6817 SOUTHPOINT PKWY SUITE 1404
JACKSONVILLE FL
32216-6282
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-1070
  • Fax: 904-260-1170
Mailing address:
  • Phone: 904-260-1070
  • Fax: 904-260-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARLA GOLDEN
Title or Position: OWNER
Credential: D.O.
Phone: 904-260-1070