Healthcare Provider Details

I. General information

NPI: 1619801685
Provider Name (Legal Business Name): KURTINA MARVIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 N MILITARY TRL
PALM BEACH GARDENS FL
33410-6507
US

IV. Provider business mailing address

1108 CHARLOTTA ST
FORT PIERCE FL
34982-4122
US

V. Phone/Fax

Practice location:
  • Phone: 772-204-0003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11047473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: