Healthcare Provider Details

I. General information

NPI: 1922922640
Provider Name (Legal Business Name): BRADEN MATTHEW MARSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 COBBLE CRK
PENSACOLA FL
32504-8638
US

IV. Provider business mailing address

1600 GOVERNORS DR APT 415
PENSACOLA FL
32514-9411
US

V. Phone/Fax

Practice location:
  • Phone: 850-473-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: