Healthcare Provider Details

I. General information

NPI: 1417465584
Provider Name (Legal Business Name): MARCKENSON GERSON JANVIER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 TURKEY LAKE RD
ORLANDO FL
32819
US

IV. Provider business mailing address

2083 WINNETKA CT
ORLANDO FL
32818-5324
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-8500
  • Fax:
Mailing address:
  • Phone: 407-485-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9335979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: