Healthcare Provider Details

I. General information

NPI: 1841922531
Provider Name (Legal Business Name): KATIE J MARKS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 E HIGHWAY 98 STE 203
PORT ST JOE FL
32456-5302
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-229-5661
  • Fax: 850-229-5662
Mailing address:
  • Phone: 904-450-6063
  • Fax: 904-539-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11019803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: