Healthcare Provider Details

I. General information

NPI: 1811965189
Provider Name (Legal Business Name): ALFREDA RENNAE MARSHALL A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 ZEAGLER DR SUITE #2
PALATKA FL
32177-6855
US

IV. Provider business mailing address

530 ZEAGLER DR SUITE #2
PALATKA FL
32177-6855
US

V. Phone/Fax

Practice location:
  • Phone: 386-325-0826
  • Fax: 386-325-6419
Mailing address:
  • Phone: 386-325-0826
  • Fax: 386-325-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP3212052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: