Healthcare Provider Details

I. General information

NPI: 1679235618
Provider Name (Legal Business Name): MARIANNE FONG NG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 FOURAKER RD APT 8307
JACKSONVILLE FL
32221-6186
US

IV. Provider business mailing address

1485 FOURAKER RD APT 8307
JACKSONVILLE FL
32221-6186
US

V. Phone/Fax

Practice location:
  • Phone: 813-334-4190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11015778
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: