Healthcare Provider Details

I. General information

NPI: 1336270685
Provider Name (Legal Business Name): MARIAH LEIGH PARKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAH LEIGH HOLTERMAN

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 SE 17TH ST
OCALA FL
34471-3968
US

IV. Provider business mailing address

1015 SE 17TH ST
OCALA FL
34471-3968
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-3422
  • Fax:
Mailing address:
  • Phone: 352-351-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL2041
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9326065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: