Healthcare Provider Details

I. General information

NPI: 1649329962
Provider Name (Legal Business Name): KAREN R RAYMUND MARDER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 38TH AVE N SUITE 200
SAINT PETERSBURG FL
33710-1645
US

IV. Provider business mailing address

6450 38TH AVE N SUITE 200
SAINT PETERSBURG FL
33710-1645
US

V. Phone/Fax

Practice location:
  • Phone: 727-344-6060
  • Fax: 727-347-5586
Mailing address:
  • Phone: 727-344-6060
  • Fax: 727-347-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1088842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: