Healthcare Provider Details

I. General information

NPI: 1437890878
Provider Name (Legal Business Name): MARISSA EARLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 07/08/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S ORANGE AVE
ORLANDO FL
32801-3383
US

IV. Provider business mailing address

5510 RAINTREE TRL
FORT PIERCE FL
34982-3821
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-9551
  • Fax: 407-871-9240
Mailing address:
  • Phone: 619-997-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9774719
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberFB9774719
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number9774719
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9774719
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFB9774719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: