Healthcare Provider Details

I. General information

NPI: 1093050478
Provider Name (Legal Business Name): JAMIE MARQUES ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RODEL CV
LAKE MARY FL
32746-4859
US

IV. Provider business mailing address

601 CANYON STONE CIR
LAKE MARY FL
32746-3973
US

V. Phone/Fax

Practice location:
  • Phone: 407-977-4130
  • Fax: 407-977-4139
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9185439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: