Healthcare Provider Details

I. General information

NPI: 1154590404
Provider Name (Legal Business Name): MARILYN HERRERA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 NEMOURS PKWY
ORLANDO FL
32827
US

IV. Provider business mailing address

10140 CENTURION PKWY N FL PROVIDER
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-4000
  • Fax:
Mailing address:
  • Phone: 904-697-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberNP17952
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9484931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: