Healthcare Provider Details

I. General information

NPI: 1811659600
Provider Name (Legal Business Name): MARIE BOONE APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DR
MELBOURNE FL
32901-2607
US

IV. Provider business mailing address

PO BOX 510002
MELBOURNE FL
32951-0002
US

V. Phone/Fax

Practice location:
  • Phone: 321-361-5568
  • Fax: 321-951-3124
Mailing address:
  • Phone: 321-477-0907
  • Fax: 321-477-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: