Healthcare Provider Details

I. General information

NPI: 1043126683
Provider Name (Legal Business Name): MARVETTE WALDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 WATER ST APT 321
JACKSONVILLE FL
32204-1662
US

IV. Provider business mailing address

799 WATER ST APT 321
JACKSONVILLE FL
32204-1662
US

V. Phone/Fax

Practice location:
  • Phone: 904-755-7423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA488376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: