Healthcare Provider Details

I. General information

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

Provider Other Name: LAUREN J MARCHEFKA FNP

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 COUNTY ROAD 210 W STE 5
SAINT JOHNS FL
32259-1180
US

IV. Provider business mailing address

4021 COUNTY ROAD 210 W STE 5
SAINT JOHNS FL
32259-1180
US

V. Phone/Fax

Practice location:
  • Phone: 904-922-3258
  • Fax: 904-664-5643
Mailing address:
  • Phone: 904-922-3258
  • Fax: 904-664-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11026734
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000148
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11026734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: