Healthcare Provider Details

I. General information

NPI: 1538590021
Provider Name (Legal Business Name): LAUREN J MARCHEFKA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN J MARCHEFKA FNP

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 VALLEY RIDGE BLVD STE 101
PONTE VEDRA BEACH FL
32081-5171
US

IV. Provider business mailing address

4210 VALLEY RIDGE BLVD STE 101
PONTE VEDRA BEACH FL
32081-5171
US

V. Phone/Fax

Practice location:
  • Phone: 904-593-8480
  • Fax:
Mailing address:
  • Phone: 904-593-8480
  • Fax: 904-593-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: