Healthcare Provider Details

I. General information

NPI: 1437825007
Provider Name (Legal Business Name): HOLLY MARIE MARPLE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1472 SW BARTELL AVE
PORT ST LUCIE FL
34953-5369
US

IV. Provider business mailing address

1472 SW BARTELL AVE
PORT ST LUCIE FL
34953-5369
US

V. Phone/Fax

Practice location:
  • Phone: 651-756-9886
  • Fax:
Mailing address:
  • Phone: 651-756-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10038798
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberL5-0000132
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61649458
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8358
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: