Healthcare Provider Details

I. General information

NPI: 1457987026
Provider Name (Legal Business Name): MARNI SAPOLSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7741 POINT MEADOWS DR STE 207
JACKSONVILLE FL
32256-9202
US

IV. Provider business mailing address

11713 HAMRICK PL
JACKSONVILLE FL
32223-0710
US

V. Phone/Fax

Practice location:
  • Phone: 904-997-0023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: