Healthcare Provider Details

I. General information

NPI: 1679110316
Provider Name (Legal Business Name): MARJORIE MATHENY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 A C SKINNER PKWY STE 160
JACKSONVILLE FL
32256-6953
US

IV. Provider business mailing address

3241 HIDDEN MEADOWS CT
GREEN CV SPGS FL
32043-7051
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-3333
  • Fax: 904-493-2222
Mailing address:
  • Phone: 904-616-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11002222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: